Scrubs, Ties and Stethoscopes

(Another 2010 piece, still relevant, perhaps especially the part about scrubs leaving the hospital/clinic with nursing staff who often have closer physical contact with patients than the doctors...)

There is a debate going on about whether doctors’ neckties can and do transmit resistant bacteria to unsuspecting patients. Some people are trying to prohibit doctors from wearing them. So far, the evidence has not supported the notion that ties actually spread disease, but this is an emotionally charged issue. 

In my part of the country you see maybe half the doctors wearing a tie and they often also wear a lab coat. The other half tends to wear open-collared plaid shirts and no lab coat. From an infection control point of view, wearing your street clothes without a lab coat when seeing patients all day in the office seems like a more questionable practice than sporting a tie tucked inside a white lab coat.

A fellow Swedish physician doing his residency in New York pointed something out in his Swedish language blog that I also found striking when I first got here: A lot of nursing personnel wear their scrubs not only in the office or hospital, but they wear them on their way home in the family car or on the subway. They wear them when they stop at the grocery store, and they wear them when they greet their children after work. That is probably a bigger infection control problem than physicians’ neckties.

One thing that even the plaid-wearing country doctors carry around the neck is quite possibly a real infection hazard, but I seldom hear anybody worry about it: Our trusted stethoscopes go everywhere we go, dangling from our necks or tucked into our lab coats and our sport jackets. We use them on people’s chests and abdomens and also when we listen to arteries on their necks and in their groins.

When did you last see a doctor sanitize his or her stethoscope?

More important than physicians’ choice of clothing is the alarmingly low rate of hand washing among physicians – 40% to 60% of the instances when they should, depending on which study you read.

The benefit of hand washing isn’t exactly breaking news. One of the earliest stories of medical discoveries I read in medical school was about hand washing. Semmelweiss noticed that midwives seemed to have fewer cases of postpartum womb infections among their patients than the physicians-in-training at his hospital. The difference seemed to be that the midwives and their hands stayed on the labor wards, while the residents went back and forth between anatomical dissections of corpses and the delivery room. Vinyl gloves weren’t invented, and hand washing was until then entirely optional.

In my office we have alcohol hand gel dispensers in every room and in the hallway. I use them on my hands and my stethoscope. I wear a lab coat that stays at the office, and, yes, I always wear a tie. So did Sir William Osler.

Update 2023: I stopped wearing a lab coat some years ago, but I still wear a tie, unless I wear a turtle neck under my English Country Shirt on cold and windy days, especially now that I am doing all house calls.