Patients lose trust in “scruffy” UK doctors, or do they?


credit: lusi

The visual tell tale signs of a hospital doctor – long sleeved shirt, tie and white hospital coat banned in 2005 as part of the infection control measures against the spread of MRSA and C.difficil has led to patients apparently losing trust in “scruffy” NHS doctors.

According to critics, doctors no longer look like doctors. One anonymous consultant told the Sunday Times —

If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant.”

Dress code

In a bid to reduce the spread of MRSA and C.Diffficil, the NHS introduced a dress code banning ties, long sleeves and “superfluous” clothing.

The only “safe” dress options for doctors were scrubs and open necked short-sleeved shirts. A Dickie bow tie seemingly the only item at a male doctor’s disposal to set himself apart from the hospital DJ.

At the same time as the dress ban, a host of initiatives were introduced as part of the infection control measures including;

  • hand washing
  • sanitizers and gloving
  • linen handling
  • environmental cleaning
  • increased hygiene reporting

MRSA and infection control

MRSA, a “staph” germ, is the only staph strain resistant to first line antibiotics. Typically spread through physical contact, once entering the body MRSA can spread to bones, joints, the blood, the lungs, the heart, or the brain.

Serious staph infections are more common in a weakened immune system; patients most vulnerable are those in hospitalized for long durations, on kidney dialysis, cancer patients or those who have had surgery within the last year.

The Health Public Authority (HPA) now publish MRSA and C.difficile infection data for every hospital each week. Mandatory surveillance now also includes figures for MSSA (Methicillin-Sensitive Staphylococcus Aureus) and E.coli infections.

The infection control measures of 2007 have so far been successful. Instances of MRSA cited on death certificates has fallen by 77 per cent:

In 2007 – a total of 1,593 cases of MRSA were recorded on death certificates.

By 2011 – only 364 cases of MRSA were recorded on death certificates.


Critics of the dress code are however not convinced that the dress ban has had any proven effect. Dr Stephanie Dancer, medical microbiologist in NHS Lanarkshire and member of working groups on antibiotic prescribing, MRSA and hospital cleaning, speaking on Radio 4 to Mark Porter on Inside Health commented –

“Yes figures of MRSA – certainly we have seen figures for those plummet, but to say that is attributable to the dress code? No, I don’t think we can say that. I don’t think there’s any evidence to support that.”

Dr Dancer added that is is not the lack of doctors in ties that has reduced infection rates, it is instead the result of a “bundle” of initiatives introduced since 2007. The compulsory scrubs she claims have simply “eroded the doctors status.”

NHS “v” private hospital

Mark Porter on Radio 4’s Inside Health noted the “transformation” seen in doctors attire depending on whether they were working within a NHS or private hospital. The very same senior doctors seen working bare below the elbow for the NHS will “transform into full pin stripes” for consultation work in private hospitals. Dr Stephanie Dancer added –

If the suit is good enough for the private hospital, it’s good enough for the NHS.”

Will the US follow suit?

Unlikely. In the US, the American Medical Association (AMA) considered adopting a similar UK dress code in 2009. A proposal for a “no hospital coat” policy was scrapped after US doctors voiced heavily in favor of keeping their traditional hospital garb. Dr Mark Hochberg, a professor of surgery at NYU’s Langone Medical Center claimed that a physician wearing a white coat was a symbol of 20th century medicine.

The US debate was policy free, but not mirth free with many suggesting the bare option, started by “Anonymous” on the “Not Running a Hospital Blog”

Anonymous said…

I guess, if we are going to be absolutely safe, doctors should be naked.”

Doctor’s prognosis

What do doctors think? Opinion is divided. However, Dr Jonathan Afoke, Cardiac Surgery Registrar at Leeds General Infirmary commented that his identity as a doctor had nothing to do with his dress code.

Appreciating the need for basic professional attire and a personal tendency to opt for a pressed shirt and trousers, Dr Jonathan Afoke felt that the role of being a doctor was summarized aptly within a quote from a patient —

I had all these strange people I’ve never met see me every day, but I always knew that you would sit down with me and my family every day to explain things, so you’re my doctor.”

Hippocrates set out principles 2,500 years ago for doctors to adhere to, much of which makes up the professional code of conduct for doctors today. One notably reminds the practitioner to remember that the patient is a human being —

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being”

For this, you don’t need a hospital white coat, shirt, or Dickie bow tie.


NHS dress code recommendations

Hospital Infection figures

Radio 4: Inside Health

Not Running a Hospital blog spot