# White Coat Medical Student - pairing dress shirt tie - Go Darker?



## ssman (Oct 13, 2007)

I do not have any sense of pairing colors/patterns, or really any sense whatsoever re: clothes comparatively speaking.

[I made an effort doing various searches to find some aforementioned advice, but no pertinent info was found]

A white coat is stark sterile white. Most dress shirts are fairly bright (whites/blues) also. What to do?

I've seen all white work for a pale old greying doc, but otherwise generates a washed out or levitating head phenomenon? https://jewishjournal.com/images/iranianamericanjews_images/Dr.-Rafi-Headshot---White-Coat-721548.jpgHere's just some examples I thought make more sense for a younger person, and have some more personality? Problem is all of these individuals have dark shirts which I'm not finding on brooksbrothers, neiman marcus, saks, etc online, or when I went to b&m Nordstrom rack, etc.

Charcoal: 
Darker Blue: https://karthik3685.files.wordpress.com/2007/11/doctor-2.jpghttps://www.midwestern.edu/Images/Blog Content Images/White_Coat.jpg
https://medicine.usfhealthalumni.net/photos/images/2430/WhiteCoat_2004_group.jpghttps://www.midwestern.edu/Images/Blog%20Content%20Images/White_Coat_2008_Candid01_F.jpg
I will now await an oracles keystrokes


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## arkirshner (May 10, 2005)

The standard professional man's ensemble is dark jacket/ light shirt/ tie. Even lighter jackets, like seersucker, are worn with the light shirt/tie.While it may make sense aesthetically to try to reverse the tonality to light jacket/dark shirt, tie, the fact is that men's clothing is not all about aesthetics, it is about associations and traditions. Although looking good is always a consideration, what is of paramount importantance is to be appropriate.



One wears a lab coat over the clothes one wears to work. The reason you are not finding dark shirt with ties on BB etc. is because they are associated with those who work for the Sopranos. To be blunt, in the pictures you posted, the men in dark shirts and lab coats look like orderlies. 
As Cuff pointed out in a recent thread, a shirt and tie, work without a jacket is the uniform of a fast food manager. 

A proper professional wears a jacket over his shirt and tie. A lab coat is simply the substitution of one coat for another. ( Strictly speaking, a jacket is a subspecies of coat, eg. "sportcoat"). A well dressed physician wears a jacket/shirt/tie to work, and exchanges his jacket for a labcoat. Sportcoats are often worn instead of suits as suit pants are not particularly suited to the job as they can easily gets soiled. After work he takes off the labcoat, puts on his jacket and goes home. He never will be confused with a fast food manager. 

While you want to show some "more personality", work is not the place. Patients want to see their physicians attending to their needs, not showing personality. This is particularly so when the physician is young. After work "more personality" is great. Here pairing colors and patterns take over and dark pattern sport shirts without a tie can be a great part of looking good.

There are a number of physicians who are members here and perhaps they will give us their insight.


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## Haffman (Oct 11, 2010)

I'm a doc, albeit in the UK.

I would recommend that you wear a white shirt, with a light stripe/check if you wish. This is in the interests of looking conservative and professional, as you should, and also because it will be pretty clear if you have splattered yourself with something, in which case you should change your shirt in the interests of hygiene and infection control. (Also if you are drenched in sweat after running around the hospital its less likely to show up than a blue shirt, which is the other conservative/professional choice.)

As for a tie, in some ways its better if you don't wear one at all as they don't tend to get laundered and could theoretically be a magic carpet for bacteria. If you do wear one (or have to wear one) then use a clip so it doesn't smack onto the patient when you are leaning over them. (In my field of psychiatry I am apparently not allowed to wear a tie on the wards, apparently because as well as infection control it might be used to strangle me.....hmmm)

Its an area where good taste and style has to take a backseat to issues of practicality... at least you can wear some nice shoes (just make sure you can run in them!)

Good luck with your training


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## zzdocxx (Sep 26, 2011)

Haffman said:


> I'm a doc, albeit in the UK.
> 
> I am apparently not allowed to wear a tie on the wards, apparently because as well as infection control it might be used to strangle me.....hmmm)
> 
> . . .some nice shoes (just make sure you can run in them!)


That's funny, I hadn't thought of that.

There are differences in the US in the East vs. West Coasts, with the East Coast having the reputation of being quite a bit more formal.

Also, in my experience, attire amongst pediatricians allows for more whimsical touches, interesting themed ties and so forth that might appeal to children, eg. dinosaurs, etc. One might understand how a "softer", less formal look might put children more at ease. But a lot of that has to do with personality and the ability to deal with scared kids, which is an art in itself.

And so forth.

Have a look at what your attendings are wearing to guide you. Recently a younger surgeon told me that he wears a suit two days a week, which are the days he mostly sees patients in the office -- you get the idea. He still wears a coat and tie the other days.

Good luck!


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## inq89 (Dec 3, 2008)

I'm a pharmacy student but I've found that a classic blue OCBD works well with the white coat, paired with red or green ties (which incidentally is the academic color for medicine). Depending on your style OP, Trad is perfect for the medical field imo, since its more conservative and professional. You can get away with some preppiness such as a plaid tie or pink OCBD with a black knit tie, but wouldn't go too full blown with bright yellow pants on rounds or anything. Although recently I wore my "blueberry blue" RL Preston chinos with my walnut AE Westchester loafers and received some positive compliments. I've seen some Physicians get away with bowties since they carry less of a chance of harboring bacteria.

I just completed my introductory hospital rotation this past month. I plan on updating my blog (look below) with pictures of my white coat combos, if you'd like some examples to work with. Hope to update by next week, will contact you OP when I do.


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## TheGreatTwizz (Oct 27, 2010)

Haffman said:


> (In my field of psychiatry I am apparently not allowed to wear a tie on the wards, apparently because as well as infection control it might be used to strangle me.....hmmm)





zzdocxx said:


> That's funny, I hadn't thought of that.


I've heard that more than once.

As a side note, if wearing a tie, the Tie Align product is a great alternative to a tie bar/clip.


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## catside (Oct 7, 2010)

Nobody will confuse Eric Kandel with an orderly. This is how it's done if you have gusto:










There is also chic, w/o gusto, a fine doc though once you past the glitter


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## Balfour (Mar 23, 2012)

I think arkirshner has given the model answer to the question posed in this thread. I agree with the subsequent comment that the "trad" look may combine the practical with a look that is conservative and elegant.

There do seem to be a number of practical strictures for medicine these days, that may be incompatible with elegant dress. The British Prime Minister was upbraided by a surgeon on a hospital visit last year for not a wearing short sleeved shirt, which apparently is required on the ward: https://www.bbc.co.uk/news/health-13771099. I know of no look worse than that of a short sleeved shirt paired with a tie / suit / odd jacket.


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## Haffman (Oct 11, 2010)

Balfour said:


> There do seem to be a number of practical strictures for medicine these days, that may be incompatible with elegant dress. The British Prime Minister was upbraided by a surgeon on a hospital visit last year for not a wearing short sleeved shirt, which apparently is required on the ward: https://www.bbc.co.uk/news/health-13771099. I know of no look worse than that of a short sleeved shirt paired with a tie / suit / odd jacket.


Yes, true - most NHS wards require either short sleeves or sleeves rolled up, although ties are also banned in many cases (infection control) so the 'fast food manager look' is averted. White coats are rarely seen, except on medical students, and less so nowadays on them. The next casualties to the infection control brigade will be watches and wedding bands...

...sometimes its hard to know whats more unsettling on the wards, the risk of hospital-acquired-infection or the state of dress of the medics in attendance...


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## bluesman (Aug 17, 2009)

As a professor at a major medical school and an academic surgeon for 37 years, I can confirm the words of the great sage...



You need to find out what's expected of you for each rotation or location to which you're assigned. Ties are vectors that carry infection from patient to patient - there are currently regulations proposed in many hospitals and locations around the country to ban ties from all patient care settings. Along with this is a move to promote short sleeves and ban watches or other jewelry for the same reason.

So you may be expected to wear a tie if you're rotating through a private practice or other outpatient office setting but not to wear one on hospital nursing units. You'll have to ask if you're not told and don't have a chance to observe.

Avoid shirts, ties and anything else that will call attention to themselves - you can't go wrong with blue or white oxford or broadcloth. Subtle embellishments like a fine blue/white OC stripe or even a pale yellow OC are fine. But patients are and appropriately expect to be the focus of attention, while attendings and residents expect students to be focused on their work as well as their patients. The old adage to blend in with your classmates academically (to avoid being asked questions you can't answer and other embarrassments) was as foolish 150 years ago as it is now. Blend in sartorially while distinguishing yourself academically and socially, and you'll be fine. But if you're lucky enough to work in a modern healthcare setting, you'll not be wearing a tie.


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## hawkmd (May 20, 2012)

I think arkirshner gave a great response. Personally, I stick with blue or white/patterned shirts with a white coat in clinic. As has been mentioned previously, if you wouldn't wear the shirt paired with a suit or blazer, I wouldn't wear it to simply contrast the white lab coat.


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## sqroot3 (Jun 13, 2012)

I am a young surgeon. Appropriate dress will depend on where you will be studying. Dress in medicine on the west coast of the states is, largely, haphazard. At most academic centers you will see many attendings wearing fast-food manager outfits--tie, shirt, and slacks--often with ties tied egregiously short or long. 

As a medical student, your dress will matter little; your work ethic will matter much. Dress neatly, and let your hard work take you the rest of the way. Always bring your fomite of a tie, and wear it when everyone else does. A dark shirt showing through the thin sleeves of your white coat is just plain ugly, but don't let that rule out a tasteful navy blue shirt.

For your ID photo, avoid the white or near-white shirt. Badge photos are notoriously bad for the floating head effect you describe!


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## JBierly (Jul 4, 2012)

First post here. I have trained both East Coast and West Coast. Medical school was a long time ago in a far far away galaxy. Times have changed dramatically. The truth is that no one particularly cares what anyone dresses like any longer in health care. On the west coast I think this was always the case - I reflect interviewing at UCSF 30 years ago and seeing medical students in jeans! I ultimately did a fellowship there and I always wore suits to work as a fellow - I assure you I was totally the exception but too many years in NYC to let go of at least some decorum. I reflect back on the times when nurses wore hats, white skirts, and white stockings and attendings wore nice suits and ties and changed their suit jacket for a nice clean starched white jacket with linen buttons at the beginning of the day. It was a simpler time - a beautiful time. People had uniforms and pride in what they wore. By the mid 90s everyone was wearing scrubs and you couldn't tell the orderlies from the physicians. If I told a nurse that she should wear white shoes, white stockings, a white skirt, and a white hat she would laugh in my face and probably file a harassment law suit. And yet it was the norm not all that long ago. A local hospital here has finally resolved to color coded scrubs - so everyone has the same dress code just different colors. I don't wear a white coat any longer - they get dirty - they are a pain to launder and there have been times when I was refused by the cleaners because of the medical contamination concern. Ties are fomites and should be avoided in the hospital setting - especially places like the burn unit - that is fact. Makes sense to get rid of watches and anything else that can spread infection. Sorry to rain on your parade but about the best fashion thing I have seen recently is Dr Rey bespoke scrubs.

Having said that - keep it simple. With a white jacket, a white shirt is going to look somewhat bleached out but nice pinstripes can add a little life. Accordingly, I would try to stay away from simple white button down shirts. If you do wear a white shirt look for a nice fabric with some texture - of course this quality shirt may be a bit expensive on a medical student's budget. Blues are always very functional - add a lot of life to an otherwise stark world and match with many ties and still very conservative. Bottom line is a nice shirt and tie is still a nice shirt and tie and can really help what is otherwise a fairly bland uniform.

Cheers,

Jack


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## DocD (Jun 2, 2007)

I would agree that ties are not the most practical item when dealing with patients. I would also agree that a simple colored or patterned shirt in the trad style would always look appropriate.

In the hospital, I usually wear scrubs since I'm often dealing with significant infections and severe non healing wounds. However, in the great majority of these cases, there are disposable gowns outside the room to be worn while visiting or treating the patient, and to be removed when leaving the room.

I believe ties are an excellent nidus for infection, but the use of a disposable gown can be useful. There has been much controversy regarding pens, labcoats, etc., and the possibility of cross contamination. I have not heard of watches being an issue. I wear a watch, but always pull the cuff of the glove over my watch.

I also attempt to avoid ever using a pen in a patient room to avoid the obvious. However, I am on staff at about 6 hospitals, and most are doing away with pen and paper and are going electronic. In MY opinion, that opens up a whole new concern. What if Dr. Feelgood doesn't have the best infection cautions, treats his patient without wearing gloves, doesn't wash his hands and does his notes or orders on the computer. Then I come along a minute later and use that same keyboard?

It's definitely a never ending concern, and how do you ban watches and not stethoscopes? Certainly stethoscopes have greater potential to pick up organisms than watches.

Sorry to have got off on a tangent. I am on staff at a hospital affiliated with a well known and respected medical school. The students are more often than not dressed in clothes that look like an iron has never touched the clothes, with some very Soprano type ensembles. The residents are always in scrubs. The scrubs require no financial commitment and no cleaning bills, they just swap them out for another pair in the locker room!


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## bluesman (Aug 17, 2009)

DocD said:


> What if Dr. Feelgood doesn't have the best infection cautions, treats his patient without wearing gloves, doesn't wash his hands and does his notes or orders on the computer. Then I come along a minute later and use that same keyboard?


That's why good hand hygiene includes washing them both before and after each patient encounter, and why sound infection control practice includes keyboard covers or washable antimicrobial keyboards.

One of the reasons we pay attention to attire is that paying attention to details is both expansive and contagious - the more you do, the more you do and the more others see you do, the more they do. It eventually leads to a culture of doing the right thing, which includes changing scrubs before going into a procedure area, properly removing and disgarding personal protective equipment (cover gowns, masks, gloves etc), and reporting potentially unclean or otherwise unsafe observations to the supervisor of the area. We keep dedicated stethoscopes in isolation rooms and ICUs. My big push right now is for voice recognition software and biometric authentication so we won't have to touch anything to access our systems.

There's now antimicrobial clothing, too - so what we wear is changing as rapidly as what we do. I just hope we generate some evidence of efficacy before we all start wearing silver-impregnated pajamas to the hospital.


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## DocD (Jun 2, 2007)

I agree with you 100%, but that's why I said "if" Dr. Feelgood doesn't have.......... I am on staff at more than 6 hospitals (4 of which are in the same city you practice) and only one is a smaller community hospital. The remainder are larger facilities with many residency programs, and unfortunately I know of only one that uses keyboard covers. 

The scrub issue is a definite concern. I can't tell you how often I see attendings, residents, fellows, go from the OR suites to the floor to see patients and back to the OR and never change scrubs. I've seen on call residents who appear to not have changed scrubs for their entire shift, even though they may have participated in a variety of procedures on the floor or in the OR.

Your comment regarding wearing silver impregnated clothing is funny, after all silver has made it's way into our wound care products, so who knows? After all, I was in a store the other day and saw silver impregnated socks for diabetics to "decrease the microbiological organisms" that "may" contribute to diabetic foot infections.

We all see infractions regarding hygiene on a daily basis which can and should be reported. I don't even want to think about how much goes on that we don't see. In my opinion it is often analogous to a restaurant. If I see a waiter or staff do something less than sanitary, I will act on it, but we all unfortunately know there's a lot that may go on behind the scenes we will rarely see.


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## Andy (Aug 25, 2002)

ssman:

Good advice on colors!

This article linked from the Home Page may be additionally helpful:

*W*hat to *W*ear and *W*hen*
*


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## sqroot3 (Jun 13, 2012)

the Medical What to Wear and When is an excellent article, but perhaps we could update it with some of the information contained in this thread!


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## stubloom (Jun 6, 2010)

I remember reading a study about 8 or 10 years ago that evaluated the dress of doctors. The study asked a representative selection of patients to evaluate the relative quality of the care they received from a specific set of doctors. The results were illuminating: Those doctors who dressed in a shirt and tie received significantly higher grades for the quality of their care compared to those doctors who dressed in scrubs. In other words, "quality of dress" was a far stronger indicator of "quality of care" than the QUALIFICATIONS AND EXPERIENCE of the doctors evaluated in the study.

Here's another tip: Whatever combination of shirt and tie you decide works best for you, do yourself a favor. Nothing looks worse than a white lab coat that's dingy and that's been poorly pressed.


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## Tilton (Nov 27, 2011)

My lady friend is in medical school. All her guy friends on rotations with her wear light blue, uni stripe, or white shirts with a tie or bowtie and khakis or navy chinos. Fine look as far as I'm concerned. Practically, you could also put on a sport coat with that ensemble and look perfectly presentable in your office as well.

Regarding ties in hospitals, a local hospital banned ties for a while, saying that they presented a possible sanitation issue. They're since changed their policy where only administration wears ties.


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## NewStyle (Apr 25, 2012)

I think that the key here is subtlety. While the doc above with the red tie looks fine, red is a bold color and not likely to help nervous patients feel at ease.

It might be good to stick with lighter shades of blue, silver and pink for ties, simply because these are gentler colors.
I also agree that light blue and white are good basics for the shirt because they are professional, traditional and subtle. This doesn't mean that some simple patterns in those shirts can't work well, but patterns should be simple and I would keep it under 2 colors/shades within the shirt.

Pair with navy or charcoal pants and you're on your way. I would also pick black shoes for the sole (pun very much intended) reason that they will clean up more nicely than brown shoes. Unless you don't mind messing up your brown shoes, of course.


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## cdavant (Aug 28, 2005)

Ties are a bit of a problem in anatomy lab. It's been way too many years since I was a med student, but until you actually start interacting with patients your dress need be no different from college. After that, take your cues from your classmates--probably scrubs on surgery and ob-gyn and something else on your other rotations. There seems to be a big difference in cultures as you move from the left-coast eastward. 

I regularly see docs like me in private practice wearing a dress shirt and tie without a jacket--white or otherwise. I rarely have to deal with surgical wounds anymore, so my tie isn't as much a likely a source of infection as the doorknobs. And short sleeve shirts with a tie sometimes are very practical if you actually have to wash your hands 50 or more times a day. I've never seen a white coat with surgeon's cuffs, but they might make a comeback.

We regularly precept students from Duke, UNC, and Wake and they all seem to show up with a dress shirt, short white coat and tie--or they would if over 50% weren't women. You want to look neat, clean and professional when you aren't exposed to blood, gore and guts. I only drag out the white coat when docs are flocking to the legislature to lobby for tort reform.

If you wear something you could drop a blazer over and dash to a party for a college classmate graduating from law school (while you still have another year of med school and three to seven more years internship/residency/fellowship to go before you make any money and start paying off your loans) you'll be fine.

It's going to be fun. Relax and enjoy it.


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## rwaldron (Jun 22, 2012)

AS for the tie, check out High Cotton Ties (invented by a med student): https://highcottonties.com/our_story


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## Haffman (Oct 11, 2010)

DocD said:


> I have not heard of watches being an issue. I wear a watch, but always pull the cuff of the glove over my watch.
> 
> I also attempt to avoid ever using a pen in a patient room to avoid the obvious. However, I am on staff at about 6 hospitals, and most are doing away with pen and paper and are going electronic. In MY opinion, that opens up a whole new concern.
> 
> It's definitely a never ending concern, and how do you ban watches and not stethoscopes? Certainly stethoscopes have greater potential to pick up organisms than watches.


I think the reasoning is that docs are much more likely to give their stethoscopes a good scrub down with alcohol gel between patients than their Rolex! (Although stethoscope cleaning is hardly a common practice and Im not sure how much of the watch-vector fear is purely theoretical...) I agree with your other points. Sadly we havent even got to a stage where everyone is even washing their hands properly....


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## bluesman (Aug 17, 2009)

Haffman said:


> I think the reasoning is that docs are much more likely to give their stethoscopes a good scrub down with alcohol gel between patients than their Rolex!


We leave dedicated stethoscopes in isolation rooms and special care units. They're cleaned and maintained like any other equipment, precisely because personal stethoscope maintenance is "suboptimal". But physical diagnosis is essentially an historical footnote for many young docs - why bother to examine the patient when you can order a test (which also leaves time for contemplating one's wardrobe and watch while waiting for the results...:biggrin

I will caution you not to soak your cuffs too many times with alcohol-based scrub solutions - they leave your cuffs looking a bit shop worn after multiple thorough applications daily. I suspect that frequent hand washing resulted in many replacement cuffs on the bespoke shirts of the historical greats of medicine back when one had collars and cuffs replaced for wear. For those of you who don't know this, it's the origin of white collar and cuffs on non-white shirts - it was impossible to match the fabric, even with extra material from the original bolt, because of fading and wear.


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## Topsider (Jul 9, 2005)

Family physician here.

I wear a lab coat every day, with a dress shirt and tie, and dress pants or chinos with dress shoes or loafers. My lab coat (which is laundered regularly by a service) is buttoned up, and my tie remains inside it. There is NO EVIDENCE that ties pose any infection risk whatsoever. Colonization studies are meaningless. Wash your hands! Even the misguided British experiment yielded no decrease in nosocomial infections. If you're paranoid, wear a bow tie.

Re: the shirt question, IMO, blue looks the best ("regular" blue, like the traditional OCBD, not French blue - too dark), particularly if you're having your picture taken. Other solids (e.g., pink, yellow) are fine, too. Stripes and other patterns tend to show through the coat, although I'll wear them sometimes. I occasionally wear white shirts, as well, but they're a little boring. There's certainly nothing wrong with wearing a colorful tie to brighten up an otherwise monotonous ensemble.


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## Topsider (Jul 9, 2005)

From a thread on the Trad Forum. This is how it's done.

https://askandyaboutclothes.com/com...ad-What-are-you-Wearing&p=1310509#post1310509



> *inq89*
> *Member*
> 
> Join DateDecember 2nd, 2008LocationRaleigh, NC, USAPosts204​
> ...


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## inq89 (Dec 3, 2008)

Thanks Topsider, those were the pics promised to the OP. The last outfit with the blue pants represents the most extreme I'd be willing to go in terms of "calling attention to myself". I figured a medium blue tone is justifiably more conservative than a preppier pastel such as nantucket red or kelly green, which I'd never wear professionally.

I also agree that a regular blue shirt works best with a lab coat, and the first outfit illustrates that point.


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## Topsider (Jul 9, 2005)

I figured I'd throw a few in, as well. These were mostly taken for the ties.


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## sqroot3 (Jun 13, 2012)

outstanding outfits to my untrained eye. kudos.


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## catside (Oct 7, 2010)

Topsider, absolutely perfect!



However if the OP imitates this, he would attract the attention of a professor like myself who would expect the attention he paid to his outfit is overshadowed by the attention he paid to his studies. Unfair? Yes! Welcome to medicine.


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## Mox (May 30, 2012)

That is far afield from my own personal taste, but wow, I can certainly appreciate what you did. Thank you for that presentation!


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## Topsider (Jul 9, 2005)

catside said:


> Topsider, absolutely perfect!
> 
> However if the OP imitates this, he would attract the attention of a professor like myself who would expect the attention he paid to his outfit is overshadowed by the attention he paid to his studies. Unfair? Yes! Welcome to medicine.


Timing is everything, of course, and you definitely don't want to go too far over the top. I would never have worn a bow tie as a medical student.


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## eagle2250 (Mar 24, 2006)

...and a hearty well done goes out to ing89. Never has the Trad ethos been "taken so far, by so few, for the sartorial benefit of so many" using the ubiquitous white lab coat as a starting point!


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## bluesman (Aug 17, 2009)

It's great to see health professionals who are still concerned with their appearance. Whether a necktie contributes to patient infection has yet to be proven with level 1 evidence, but we'll soon be able to get more data. Now that more than half of the physicians in the US are women (few of whom wear ties), it's only a matter of time before someone does a comparative study of hospital-acquired infection rates in patients who've had contact with only male vs only female physicians.

Personally, I like bow ties and have several. But there's evidence that the contamination rate is the same for a brand new tie after wearing it for one day as it is for a bow tie after wearing it to work in a hospital for 3 days (e.g. Biljan, Hart, Sunderland et al. BMJ. 1993;307:1582-1584). As for keeping your white coat buttoned over your tie, Treakle, Thom, Furuno et al (Am J Infect Control. 2009;37:101-105) found that 23% of white "lab coats" worn to a meeting by attendings, residents and students at a teaching hospital in the US were contaminated with staph aureus. And Neely (J Burn Care Rehabil. 2000;21:523-527) demonstrated that pathogenic bacteria remain viable on a 60% cotton / 40% poly blend commonly used in lab coats for up to 28 days. 

One reason for the high contamination rates is probably that we all unconsciously fiddle with the knots on our ties, badges hanging around our necks etc during the day. Kotsanas' group (Med J Aust. 2008;188:5-8) found a high contamination rate on ID badges and the lanyards that hold them around healthcare workers' necks. Handwashing is very effective, but it simply doesn't kill 100% of the microorganisms living on and in your skin. It reduces risk, but it doesn't eliminate risk.

Given the logical association between a walking bacterial reservoir and the risk of infection in those who come in contact with it (and that's not limited to patients, as healthcare workers also carry infection home and give it to their families, e.g. C Diff), I personally see no justification for continuing a practice that's been called into question for good reason. While waiting for data to prove it, there's a significant probability that at least a few people are being harmed. I recommend reserving those great outfits for times and locations in which there will be no patient contact.


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## Topsider (Jul 9, 2005)

^ Colonization does not equate to infection, and no study has proven otherwise. EVERYTHING is colonized. Until doctors attend to patients in sterile bubbles and Level 4 isolation suits, there will always be fomites. Even on scrubs worn once. Human bodies are "walking bacterial reservoirs." It's not just our clothes. The failure of the "British experiment" (nothing below the elbows) demonstrates this. https://www.ncbi.nlm.nih.gov/pubmed/20299128

Again, WASH YOUR HANDS! Before AND after patient contact.

NOTHING "eliminates risk." But, nothing else reduces it as much as this one, simple thing.


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## bluesman (Aug 17, 2009)

Topsider said:


> ^ Colonization does not equate to infection, and no study has proven otherwise.


This forum is hardly the place for a medical debate. The reason I jumped in at all is that everyone reading this thread is a healthcare consumer. Some of the things stated in this thread could be alarming to non-physicians, and some might even get the impression that a doctor could compromise their health because of personal preferences. A lack of evidence for something is not evidence against it. A randomized, controlled trial comparing the hospital-acquired infection rates of patients of tie-wearers vs case-matched patients of non-tie wearers would require so many patients, so much time, and so much money that it will never be done.

Colonization has been clearly shown to be associated with higher infection rates in situations more readily lending themselves to study, e.g. nasal colonization with MRSA is clearly causally associated with surgical site infection with MRSA. Wearing a staph-impregnated tie cannot be dismissed as an infection risk simply because no one has demonstrated an increase in infection rates among patients cared for by the wearer.



Topsider said:


> WASH YOUR HANDS! Before AND after patient contact...nothing else reduces it as much as this one, simple thing.


Following your logic, no study's been done to confirm this either. While hand hygiene is known to reduce infection rates, so are many other interventions none of which has been subjected to comparative study "against" hand washing. We have to use the best available evidence, which may be limited to logic and expert opinion.

I agree that all clothing is a vector. We'd probably reduce hospital-acquired infection rates by wearing freshly laundered scrubs and changing them halfway through each work day and after contact with greater-than-baseline infection hazards. The guiding principle of medicine has been "primum non nocere" for many many years. In addition to telling me to wash my hands, this dictum tells me to leave my ties at home when I go to the hospital.


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## Topsider (Jul 9, 2005)

bluesman said:


> This forum is hardly the place for a medical debate. The reason I jumped in at all is that everyone reading this thread is a healthcare consumer.


All the more reason for you to stop spreading baseless paranoia, and act as if leaving your tie at home is somehow the solution.


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## Haffman (Oct 11, 2010)

The single-centre study you refer to as conclusive of the "failure" of the "British experiment" (bare below the elbows) seems pretty under-powered to me as a basis to draw your conclusion that the policy has failed. And to be clear, in Britain there is no sense that this policy has "failed" and indeed it is becoming more embedded. 

My take is simply - why take the risk, for the sake of a tie ?


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## Topsider (Jul 9, 2005)

Haffman said:


> The single-centre study you refer to as conclusive of the "failure" of the "British experiment" (bare below the elbows) seems pretty under-powered to me as a basis to draw your conclusion that the policy has failed. And to be clear, in Britain there is no sense that this policy has "failed" and indeed it is becoming more embedded.
> 
> My take is simply - why take the risk, for the sake of a tie ?


There are other sources which basically convey the same information. You are free to research these on your own.

If you can point to any studies which document a statistically significant decrease in the rate of nosocomial infections since the policy was initiated, please feel free to do so, as well.

My take is simply - why inflict one's opinion on others without convincing data? Do what you like. Just don't try to make me do it until you can prove that it matters, particularly since we still have much work to do in getting people to do the one, simple thing that truly DOES matter - washing their hands.


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## Shaver (May 2, 2012)

Wow! There some truly admirable bedside manner being exhibited here. *ahem*

I'm scared to become sick now. :eek2:


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## Haffman (Oct 11, 2010)

Topsider said:


> Do what you like. Just don't try to make me do it...


I wasn't aware that I was. Now who is becoming paranoid ?!


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## Topsider (Jul 9, 2005)

Shaver said:


> Wow! There some truly admirable bedside manner being exhibited here. *ahem*
> 
> I'm scared to become sick now. :eek2:


[irony]Says the smoker.[/irony]

None of you are my patients, and this isn't your bedside. We're still talking about clothes.


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## Topsider (Jul 9, 2005)

Haffman said:


> I wasn't aware that I was. Now who is becoming paranoid ?!


Technically, it was "bluesman" who started sermonizing, but you did pile on.


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## Shaver (May 2, 2012)

Topsider said:


> [irony]Says the smoker.[/irony]
> 
> None of you are my patients, and this isn't your bedside. We're still talking about clothes.


Frankly, irony or no, I am totally unable to see what relevance my smoking has to this?

PS: oh, hang on! is it because it will make me sick? Ahh, gotcha! Very droll.


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## Topsider (Jul 9, 2005)

Shaver said:


> Frankly, irony or no, I am totally unable to see what relevance my smoking has to this?


I was referring to the "scared to become sick" part. Apparently, you aren't. 

You had a recent debate in the WAYW thread, which is the only reason I even took note.


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## Shaver (May 2, 2012)

Topsider said:


> I was referring to the "scared to become sick" part. Apparently, you aren't.


Sorry the penny did drop, as per my PS edit above. I hang my head in shame.


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## Topsider (Jul 9, 2005)

Shaver said:


> Sorry the penny did drop, as per my PS edit above. I hang my head in shame.


I should've used a smiley in the first place. I always appreciate irony.


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## Haffman (Oct 11, 2010)

Topsider said:


> Technically, it was "bluesman" who started sermonizing, but you did pile on.


I wished only to correct the potentially misleading assertion that the "British experiment" had "failed"

If you refer to my earlier posts you will see that I stated clearly that hand washing is vital and still not being done properly. I also mentioned that in the UK ties are not generally worn on the wards and that rings and watches are next to go.

As previously stated, I am 'not allowed' to wear ties because they might be used to strangle me. I would be surprised if that is an evidence-based policy, as I haven't seen a study of psychiatrists with ties versus psychiatrists without ties, and how many got strangled. However, it seemed reasonable and I have gone along with it. I take a similar view to dispensing with neckties when in hospitals, given the scourge of hospital acquired infections, and how rarely my ties are washed/disinfected, even in the absence of a multi-centre trial. I see from this thread that a number of your esteemed American colleagues feel the same way.

However, just to be clear, I fully support your right to be of a different opinion and concur that there is a lack of evidence although I do not accept that there is sufficient evidence to disprove the theory. As you will be aware, there are a number of procedures, techniques and even drugs that have survived in medical practice despite the lack of an RCT or similar evidence based medicine to back them up. I admire your willingness to challenge the new orthodoxy on the basis of evidence, but feel that you have reached a conclusion too quickly, that is all.


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## Topsider (Jul 9, 2005)

The only conclusion that I've reached is that in the absence of convincing evidence, all we're really talking about is our opinions or beliefs. That's much closer to arguing religion than science. 

Most of us wouldn't tolerate having another person's religious viewpoints forced upon them, so I fail to see why we should be any more accepting of other unproven beliefs, no matter how "logical" they may appear on the surface.

As far as strangulation goes, definitive prevention would require that you place all of your patients in handcuffs.


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## Haffman (Oct 11, 2010)

Topsider said:


> definitive prevention would require that you place all of your patients in handcuffs.


Its been tried before. Thankfully, not so much since the late 18th Century...


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## Topsider (Jul 9, 2005)

Haffman said:


> I wished only to correct the potentially misleading assertion that the "British experiment" had "failed"
> 
> If you refer to my earlier posts you will see that I stated clearly that hand washing is vital and still not being done properly. I also mentioned that in the UK ties are not generally worn on the wards and that rings and watches are next to go.


Worth a look: https://www.slideshare.net/PracticalHT/pants-policies-and-paranoia


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## Tippo (Jul 1, 2012)

Surgeon,
I wear a suit and tie to work. Go straight in the operating changing room, change to scrubs and change back when I finish.


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## Topsider (Jul 9, 2005)

bluesman said:


> Now that more than half of the physicians in the US are women (few of whom wear ties), it's only a matter of time before someone does a comparative study of hospital-acquired infection rates in patients who've had contact with only male vs only female physicians.


You'd have to account for hand lotion, jewelry, and long fingernails - any of which can reduce the efficacy of handwashing.


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## cdavant (Aug 28, 2005)

I find that maintaining a blood alcohol level in the range of .04-.07 will not only decrease your concerns about being a source of infection but about health care in general. Alcohol remains a very good disinfectant used both internally and externally.

Next time I forget my badge I'm going to say it's out being sterilized...


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## Topsider (Jul 9, 2005)

cdavant said:


> Next time I forget my badge I'm going to say it's out being sterilized...


As were you, hopefully. 

"I keed, I keed!"


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## cdavant (Aug 28, 2005)

Topsider said:


> As were you, hopefully.
> 
> "I keed, I keed!"


I'm happy to report that my last sexual harassment complaint has been reduced to assault with a dead weapon...


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## Topsider (Jul 9, 2005)

cdavant said:


> I'm happy to report that my last sexual harassment complaint has been reduced to assault with a dead weapon...


:biggrin2:


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