Dr Phil Hammond, broadcaster and GP returner in Bristol

Is your choice of neckwear linked to MRSA?
Should doctors be allowed to wear ties at work? Not according to Dr Matthew Fletcher, the Medical Director of Brighton and Sussex University Hospitals NHS Trust, who has ordered all staff involved in direct patient care to abandon not only their ties, but also any 'superfluous clothing' or ornaments,1 (e.g. jewellery, watches, scarves, toupees, merkins*).

This follows a report from the BMA urging doctors to abandon neckwear because it can be a vector for MRSA.2 As Dr Fletcher put it: 'We do know that this will involve a culture change as many doctors are used to wearing a jacket and tie, particularly when delivering bad news, and many patients expect doctors to look smart. The simple fact is reducing the spread of infection is more important than looking smart, and both doctors and patients need to accept that ties are not essential for the delivery of a professional service and good healthcare.'1

This seems fine to me, provided the evidence stacks up that reducing ties reduces the risk; and besides, the Australian half of me has never enjoyed being strangled by a silk ribbon. But for doctors who've built their persona around an old-school tie with an immaculate Windsor knot, or even a proper tie-your-own dickie bow, I can see it's a bit of a blow.

Dr Michael Dixon, GP and Chairman of the NHS Alliance, and a man I admire more for his leadership than his bow tie, apparently told the Sunday Times that research showed patients had more confidence in smartly-dressed doctors. 'I certainly would feel less professional if I was not wearing a tie. It is all right if you are an Antipodean doctor, but not in this country. This is political correctness rather than science.'1,3 An unnamed consultant at the trust was equally dismissive: 'If you come to see a consultant in Brighton, you will be greeted by an open neck shirted doctor who will look as if he is the hospital DJ.'3

This Sunday Times story was widely reported elsewhere on the Monday, and by Tuesday the opinion writers had kicked in. Thomas Sutcliffe, writing in the Independent under the headline Tongue tied-medic has a lot to learn illustrated the danger of putting your name to a quote (rather than remaining anonymous). Dr Dixon's reaction was 'apparently impatient' and suffered from 'reflexive pomposity and stupefyingly muddled logic'.4 If Jose Mourinho had said that of Arsene Wenger (or the other way round), there'd be handbags — or even writs — at dawn. Let's hope our Mike can take it on the chin.

Sutcliffe's argument is that MRSA is not 'a figment of some sociologist's overheated sense of social injustice', nor has it been 'dreamt up by a hygiene business hoping to open a new market.'4 It's a killer on the rise, with 3500 blood stream infections reported between October 2005 and March 2006 alone.5 He also points out: 'some patients don't like to be referred to as if they're benighted peasants who can be hypnotised into biddability by a bit of dangling silk.'4

I suspect this is an argument Dr Dixon is not going to win, given that Sutcliffe boasts a lot more column inches. It's rather like a comedian putting down an errant heckler. But if we want patients and relatives to take hospital hygiene more seriously, we should be leading the way; and if that means consulting naked, shaved, and with our dangly bits held back by duct tape … then so be it.

The wider message is clear too. If you're a doctor in the public eye, and everyone has your phone number, you are allowed to say NO to a quote. I do it all the time. But maybe that's because I'm a journalist too, and I know what 'they' can do to you.

*counterfeit hair for the private parts!

1. www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/12/18/nmrsa18.xml
2. www.bma.org.uk
3. www.timesonline.co.uk/article/0,,8122-2508284,00.html
4. http://comment.independent.co.uk/columnists_m_z/thomas_sutcliffe/article2086725.ece
5. Health Protection Agency. Mandatory Surveillance of Healthcare Associated Infections Report 2006. London: HPA, 2006.


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