Why All Doctors Should Wear Bow Ties
Monday, May 28, 2012 at 11:11AM
Michael Hebert in Medicine

When I was in medical school, ties were required on all clinical rotations. Ties for men, equivalent dress for women. Even in surgery we were expected to remove our surgical scrubs and put on a dress shirt and tie before we rounded on the floors. It was a discipline I thought all medical students learned. When I graduated, however, I discovered that either all schools didn't teach students to wear ties, or the discipline was quickly unlearned as soon as young doctors left medical school.

To me, a tie is part of a doctor's identity, helping us stand out from the crowd in the hospital environment. About a decade ago, when my father did patient satisfaction surveys for hospitals, he found that one of the most consistent complaints was that patients couldn't figure out who was talking to them. In a hospital, everyone wears scrubs, including doctors, nurses, physical therapists, phlebotomists, and even housekeeping and transportation personnel. This can make it very difficult to tell who the person is standing at your bedside in aquamarine scrubs. Yes, people introduce themselves, but usually only once. If you meet ten different people over the course of a single hospital day, which is easily possible, you will quickly forget who is the nurse and who is the respiratory therapist -- especially if they are wearing similar clothing. In our efforts to make society egalitarian, we've succeeded in making everyone look alike, even when their roles are not.

That is one reason for doctors need to dress better. It makes them easy to identify. This puts a patient at ease and relieves her from having to rack her brain for a name and a title, at least when the doctor enters the room.

Although I would hardly call myself a fan of haute couture, I do think fashion has value. Clothing isn't simply protection from the wind, any more than food is just processed nutrients. Clothing is a language, a form of communication. And like many forms of communication, its nuances are being lost in modern life. Our insistence on casual living may make day-to-day life more comfortable, but what we lose when everything is kept informal is the more sophisticated touch formality confers. If you show up at a friend's door for dinner in a coat and tie, it says a great deal about what you think of the occasion -- and of the friend. But that custom is gone with the Edsel, and with it went an opportunity to pay another person a compliment. Personally, I think it's a shame that most people consider a dinner guest who shows up in a coat and tie to be off-puttingly stiff, instead of what is really intended -- respect, appreciation, and consideration.

I started wearing bow ties in my clinical practice in 2003. Before that I always wore neckties. I made the switch for two reasons. The first was that the long necktie would often get soiled in the course of my work with patients. The second reason was that I thought the bow tie was an offbeat choice for neckwear, and yet more in the conservative southern style of dress, which I happen to like.

One of the interesting things about bow ties is that they can be both formal (think tuxedo) and whimsical (think Bozo the clown) at the same time. They are also short, never blow over your shoulder in the wind, and once you put it on you never have to think about it again. Altogether, if you don't mind the look, a nearly perfect article of clothing. Sure, learning how to tie a bow tie takes a little effort, but after a couple of days it's as easy as tying a shoe lace.

Shortly after I started to wear bow ties at work, a study came out suggesting that doctors may spread infection from their neckties. Some physicians took this as an excuse to stop wearing neckties altogether. Many people assumed my switch to bow ties was influenced by that study, but that's not the case. Although I recognize that longer ties may accumulate bacteria, I also realize that my lab coat does the same thing and I don't intend to get rid of that. I'm not really convinced that neckties have much to do with the spread of hospital disease. Failure to observe proper hand washing techniques seems a more likely culprit.

Over the years, wearing bow ties at work has produced unexpected results. Most importantly, patients and their families immediately recognize me from my tie even if they can't remember my name. Recently, I admitted a patient through the emergency room who, when she first saw me, said, ”Where's your bow tie?” In looking through the hospital records, I saw that I had not seen the patient since 2009. Obviously, the bow tie made an impression. I've also noticed that when a patient is admitted to me to the floor, the nurses will often tell the patients that they will recognize Dr. Hébert because he will be the one with the bow tie. Although there are a few other doctors in the hospital that wear ties, I'm the only one who wears a bow tie.

The tie overcomes several important problems in patient care. First of all, patients are able to remember me, and therefore remember who their physician is. It helps them quickly identify me as a physician, which makes life easier for me, and easier for them. Second, it communicates to the patient what I want communicated -- that I consider taking care of them a formal matter, not a causal one, and that I intend to behave professionally towards them at all times. Finally, it may, at least according to one study, prevent disease. Easier identification, better communication, disease prevention. Sounds like an easy call to me.

My habit has been to wear bow ties Monday through Friday, and on the weekends an open collared dress shirt. I did this for years, but on weekends, I regularly ran into patients who would ask me why I'm not wearing my bow tie. Over time, as the challenges mounted, I caved, and these days I often wear them on weekends, too.

I have not polled my fellow physicians to see why 90% of the men refuse to wear ties to work. I think what they would say is that what matters most in medicine is that the patient gets well, not that the doctor dresses well. While I think this is logically true, it misses the point. Patients are people, not widgets. You can make widgets all day, do it well, and never respect one. You can do the same with patients, I suppose, but the outcome is not likely to be as good.

If physicians didn't believe clothing influenced doctor-patient relationships, none of them would wear white coats. The truth is, there are numerous studies in psychology that show individuals in white coats are accorded more trust and respect than people who don't. If white coats command respect, it stands to reason that a necktie would also. And in my experience, that influence is more subtle and positive than a lab coat that screams, I have a degree! I have a degree! Obey!

The reason most physicians don't wear ties anymore is because they find them uncomfortable. Which is not really true. A good silk bow tie and a shirt with a properly sized neck is not uncomfortable at all. It's just a matter of choosing the right clothing. It's also a matter of getting used to it. But even if there is some discomfort in wearing a bow tie, when a doctor refuses to wear one he is saying that he is placing his own comfort above concern for what his patient thinks. (It's not as if anyone thinks doctors don't pay attention to what patients think!)

Showing respect for another person always takes a little effort. When your neighbor comes into your home and finds you lying on the sofa watching the football game, the only way to show respect is to stand up. It takes effort. If you continue to lie on the sofa you are putting your comfort in front of his. You've sent a message, whether you intended to or not.

Some people would say that I'm making a big deal about a minor issue. I don't agree. If schooling teaches anything at all, it teaches that just because an influence is subtle, that doesn't mean it is not important. Subtle changes upend civilizations. If subtlety didn't matter, no one would choose Coke over Pepsi, a Nike shoe over an Adidas, or a BMW over a Ford. No one would choose to move south for warmer weather, and no one would pay more for a house that faces the ocean than one that is a two minute walk away. Subtlety is not only sometimes important, in most cases it is all the difference. You would think that people who try to interpret smudges on x-rays or listen to heart murmurs for a living would understand this point.

Am I saying that all doctors should be required to wear ties? No. I value personal freedom too much to dictate to others like that. My argument is more general. It is that excellence has its roots in many small things. Those who want to pursue excellence have to look for opportunities everywhere. And I don't see any easier area to step up your game than putting on a decent shirt in the morning and then adding a tie. I honestly think if every doctor in our hospital wore a tie (or equivalent dress for women), the hospital and the doctors would make more money.

But at this point, I'm one of a handful of physicians in my entire hospital who bothers to dress up at all, much less wear a tie. In some ways, wearing a bow tie makes me an outlier. It is strange to think that in our society, the guy who wears a bow tie is now the rebel. On the other hand, look at the paintings of the rebels who signed the Declaration of Independence. What were they wearing?

Article originally appeared on Michael C. Hebert, MD (http://drhebert.squarespace.com/).
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