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I'm a radiologist and writing helps me make sense of the world.

"My method is to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity" -George Bernard Shaw

Saturday 8 May 2010

Secrets and Ties

A terrible scourge of hospital-acquired infection stalks this land. It is a modern scandal and failing of our profession that we have allowed it to happen. There is no doubt we must be vigilant and do all we can to lessen it. We could argue the long and short of how best to do this. However, we are officially not allowed to. The edicts of infection control teams must be obeyed without question. Even pointing out 110% bed occupancies as a possible contributing factor is considered heretical. Anyone seen to be stepping out of line incurs the full wrath of the medical director (I speak from experience here).

Now one could harp on about a managerial hegemony, doctor bashing, lack of evidence; even a conspiracy theory. However, this particular drum has been beaten to death: nothing happened. There are few points that I could perhaps add to this dying discussion. As a non-interventionalist, I have literal patient contact only during a simple handshake or via the medium of ultrasound gel. Hence the necessity for most radiologists to be complicit with the infection control manta is questionable.

But one aspect of these changes that has made a distinct but subtle difference is the death of the tie. Our female colleagues have suffered the ignominy of having to remove treasured jewellery but this is a largely personal issue. Nowadays I can’t help thinking the plethora of open-collared shirt-wearing doctors makes the radiology department look like a louche firm of copywriters. Good-bye sartorial elegance; every day is now dress-down Friday.

Where did this come from? Well, on 17th September 2007, a Department of Health (or D’oh! as I like to call it) proclamation stated under the subheading “Poor Practice” that, “Ties are rarely laundered but worn daily. They perform no beneficial function in patient care and have been shown to be colonized by pathogens”. Unfortunately, these statements are all true. Particularly the last bit – I did a quick literature search.

You could resurrect the arguments about lack of evidence that it actually prevents infection. You could take issue that the guidelines largely refer to nurses but are taken to mean doctors too. However, my issue here is the same document also states, “It is good practice to dress in a manner which is likely to inspire public confidence”, as “general appearance [is a] proxy measure of competence”. Bit of a dichotomy, eh? Do you want a professional looking doctor or a potentially cleaner doctor? Sadly, we know the answer already.

One particular conspiracy theory cannot be totally ignored. This is the emasculation theory. This centres on the shape of the tie, plus the way it unsubtly points towards the nether regions. Hence a woolly blunted-ended tie can be seen as a direct statement of masculinity, or rather lack of it. It therefore follows that forcible removal of the tie altogether is tantamount to castration. I don’t really buy it myself, but it is food for thought.

The other aspect is the tie as a social statement. The selection of tie states membership of a certain club, or perhaps, that one is worryingly keen on cartoon characters. There is also the issue of exerting the nuances of one’s personality. Just this morning on the way into work, as I idly flicked traces of black pudding and absinthe from my College tie, I wondered what particular messages I was giving out.

We could get round the issue of infection control by all adopting bow ties. However, a professor at my alma mater used to say that wearing a bow tie marked one out as a prat. Admittedly, his actual words were a little coarser but such crudities are not for the gentle reader. Even though I know many fine gentlemen who besport bow ties, I can’t shake his words from my head. Cravat, anyone?

So, faced with an official proscription of ties, why not embrace this emancipation? Who honestly really likes the physical discomfort of wearing a tie? Surely we will all mellow slightly as an indirect result. Despite this liberality, I still feel slightly underdressed and paradoxically uncomfortable.

Alternatively, partly in demonstration, one could radically change one’s professional garb. Sadly, a set of blue scrubs makes one look like an ODA. So, where patient contact might occur it could be justified to perform all one’s professional duties dressed in the way least likely to transmit infection - wearing only a pair of swimming trunks and lightly oiled.

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