Should surgeons be bare below the elbows and tie-less, or are new United Kingdom dress rules for doctors compromising their professional image without sufficient evidence that hospital-acquired infections will be reduced? That's the question posed by urology consultant Adam Jones from the Royal Berkshire Hospital in Reading, UK, in the September issue of BJU International.
Charting the history and attire of surgeons from the early nineteenth century, he points out that it is hard to find significant evidence that the 'bare below the elbows' rule outside the operating theatre will reduce hospital-acquired infections like methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.
"The evidence for the roles of ties, shirt cuffs, rings or watches in infection is hard to find and mostly in obscure medical journals" says Jones. "Indeed similar levels of bacterial contamination have been reported on doctors' stethoscopes and pens."
However, research has shown that patients don't like to see surgeons walking around in what they perceive as casual clothing; they feel more confident in their professional competence when they see them in white coats.
"In America and much of Europe doctors change into some type of 'uniform' from their street clothes, but this has significant implications in terms of sufficient changes of clothes, laundry services and adequate changing rooms," says Jones. "Any uniform would have to confer some degree of seniority or status to maintain patient confidence."
