Rude Health: Sartorial Surgery for fashion fails
Tired corduroy, down-at-heel shoes, naked elbows and sharp stilettos. Dr Maurice Gueret on medical fashions
I raised the topic of sartorial standards amongst hospital doctors a few weeks ago, and it has drawn a heaving postbag. Much of the running was taken by an old colleague of mine, now a consultant, who despairs at some of the "get-ups" younger medics are arriving to work in. An infection-control nurse has been in touch to spread the new gospel about standards in this area. She tells me that doctors who wear white coats are not complying with current standards of HIQA, the World Health Organisation, or the USA Centre for Disease Control. Naked below the elbow is the new norm. Wristwatches are banned. One plain wedding band is allowed. And diamonds and nail polish are out for the ladies.
Such Talibanesque edicts might explain why a 64-year-old brain surgeon resigned from his position in Britain's NHS this summer to provide his skills free of charge in the Ukraine. Citing increasing bureaucracy and over-the-top safety regulations, the last straw for the eminent neurosurgeon was a 22-page-long dress code from hospital managers, which banned ties, wristwatches and long sleeves. He described the situation as a shambles, and said there was no evidence that rolled-up (or down) sleeves made a whit of difference to patient outcome. Which is the point really. Hard evidence in this field is not easy to come by.
My friend in infection control rightly points out that, with the exception of ties, white coats are the least-laundered items in modern hospitals. Which begs the question - why are hospital managers not providing clean ones at the start of each shift? Mary has been in touch with an interesting observation about the Irish. She says that, as a nation, we are not pristine uniform-wearers. She also tells me that the material in many white coats today is synthetic. The upside is that they dry out quickly, but the downside is that it precludes giving them a really good boil, which, she says with a voice of experience, is precisely what they need. Some comments I have received have been priceless. Deirdre says a dress code should be mandatory, as some male doctors now look like relatives! She wants white coats for all doctors, but washed ones. There were comments about miniskirts, skinny jeans, low tops and stiletto heels. A correspondent, who works as a nurse manager in mental health, says that it is not uncommon for consultants and senior nurses to advise young female doctors to dress more appropriately and "less provocatively" in a psychiatric setting. And the men don't escape either, with comments about crumpled shirts, mangy coats, down-in-the-heel shoes, bulging pockets and tired corduroys. It seems that, in general, our patients want smartly dressed men and less fancifully dressed ladies to do their doctoring.
Important people don't wear white coats
Richard writes with interesting philosophical views on Irish hospital dress. He says that one of the first items given to a medical student is a white coat. They love this because people actually call them doctor and they rush home to tell mammy, who also loves this. After a while, the white coat becomes a bit of a drag and so it is jettisoned. Because they have learned that the really important people don't wear white coats. Wise observation, that.
At the core of this debate, we do need a modicum of common sense. What is appropriate daily wear, such as theatre scrubs for an intensive-care baby unit, might not be appropriate for psychiatric outpatients. We also have a particularly Irish health situation, where doctors can work between half a dozen hospitals, public and private. It's easier to have good policies when your personnel are full time, on site and committed to the one institution for their working day. There are as many opinions on this subject as there are fashions. They say that clothes maketh the man. But some care more for the manner, or even the cure.
I was writing recently about the new vaccine against shingles and wondering when we were going to follow our Northern Irish colleagues and introduce a public campaign here. Well, the partially good news is that Zostavax is available for private patients over the age of 50. I don't have any information to hand on price, but it's a single-dose jab and the manufacturers, Sanofi Pasteur MSD, have a new website, www.shingles.ie, to provide more detailed information for patients. By coincidence, I had a letter from a man recently asking me to discuss post-herpetic neuralgia, which has plagued him for some years. This is a painful complication that affects one in five shingles patients, where discomfort and debility can last for months, or even longer. There are medicines to be tried and, occasionally, pain specialists will be involved in management, but the news that an effective vaccine is here is welcome.
We have well evacuated the bowels that house medical malapropisms, or the funny things patients say to doctors, but a good one arrived recently from Kieran, whose mother is a retired nurse. One day, she overheard some elderly patients in conversation about funerals and burials. The dread of being buried alive was a common fear, and one old lady exclaimed, "I would definitely not wish to be buried. No way. "When I die, I want to be consummated!"
Dr Maurice Gueret is editor of the 'Irish Medical Directory'