Friday, 4 January 2008

What Not to Wear

From Jan 1st 2008, our hospital trust has implemented a 'bare below the elbow' policy following advice from the Dept of Health. A detailed email was sent to all the medical staff (whom this encompasses i'm not sure, it may just be the doctors or it may-be all of the people who come into contact with patients). Medical staff are no longer allowed to wear: long sleeved shirts (or at least they must be rolled up), ties (unless tucked in), jackets (this is going to piss the consultants off), watches, or anything else below the elbow, a solitary ring (gold band) may be worn.

A recent BBC article covered this story, in particular with regards to doctors not being allowed to wear watches. Research showed that doctors were unable to estimate accurately pulse and breathing rate. Personally I think the restriction on watches is going a bit too far, I hate not wearing a watch, especially as the BBC article says, there are very few clocks around the hospital. I can't see many of the consultants being willing to follow the watch part of this policy but I guess we'll have to wait and see. Particularly as many don't even bother to alcohol gel their hands between patients.

What's next? A latex skin tight uniform which can be wiped down between each patient?

This topic brings up another argument as to whether doctors, having disposed of the stereotypical white coat should have a uniform. Personally I think we should all be able to wear scrubs all of the time, but apparently that doesn't match with the professional ethos that doctors are supposed to emit.

I suppose it gives students something else to worry about in OSCEs, i'll be sure to make a point that "I'm observing the bare below the elbow policy".


AMiB said...

there go the new french cuff shirts i had planned to wear at clinics...

missbliss said...

It looks ridiculous when sleeves are rolled up and tie tucked in. It's just not a good look.

I'd rather everyone wore scrubs. I'd also like to see everyone wearing clear ID badges - throughout the nhs including at GP surgeries. I once poured my symptoms out to someone taking my blood pressure and she turned to me and snapped, "well you'll have to tell the doctor that, I can't help you."

I'm not surprised doctors aren't alcohol-gelling between patients - your hands went all dry and flaky because of the constant use of alcohol gel. I thought only professions like carpentry and building damagedw your hands!

Elaine said...

Umm, but what about the danger of those vast areas of unwashed skin coming into contact with the patients - if consultants won't wash their hands, what is the liklihood of their washing to the elbows between patients?

Love the concept of a skin tight latex suit!

Ms-Ellisa said...

Are you kidding me...?

All the doctors here wear white coats, except the surgeons when in surgery. If they don't, they are regarded with "What? Then how will people tell that you're a doctor?"...

Even the concept of scrubs is waaaaaay far off still for most.

In my opinion everybody should wear scrubs...

Oh- and I really need my watch...

Merys said...

white coats are banned here throughout the hospital except the lab. You see I dont mind wearing a fob watch when I'm a HCA, but it's gotta be a chore as a med student. It's also not always that helpful!

Anonymous said...

What worries me is that I could actually see them debating whether to implement a latex skin tight uniform at some point in the future!

I dread my first OSCE, it sounds like something I just will not be able to take seriously...

the little medic said...

amib - all my shirts are long sleeve and i've got a load of ties. Guess in future i'll have to get some short sleeved shirts!

missbliss - that reminds me, I keep forgetting my ID badge.

elaine - yes, I wondered about the unwashed skin too, surely thats going to have its fair share of bacteria!

ms-ellisa - I can't even remember the last time I saw a doctor wearing a white coat here. I think like where merys is they may well be banned.

If we all wore scrubs, life would be a whole lot more like Scrubs the TV show which would be cool

merys - I don't much fancy a fob watch but that might be the way things end up at this rate.

harry - even the concept of OSCEs used to scare me shitless well before i'd done my first one. To be honest, they are quite scary but they're not anywhere near as bad as I thought they'd be. You'll be fine

Emma said...

the bit that everyone forgets is what about the bacteria that alcohol gel doesn't kill, and the stethoscopes which are carried between patients and not cleaned?!
Umm wore long sleeve to my OSCE this morning....fingers crossed i didn't get minus marks for that!

Anna said...

I really wish we wore scrubs all the time - then I could rock up to hospital in whatever I liked before getting changed. I fear that would eventually lead to me turning up in my PJs... During a particularly dull standing on the ward waiting for teaching session, my firm devised a system of colours for broad specialties, with bands on the sleeves for training level. We also decided medstudents should have their own colour. Would make identifying (and therefore avoiding) consultants much easier!

As for me, I've been embracing the bare below the elbow thingy since September. I hated not wearing my rings to start with but I've got used to it now. And I'm even managing with my nurse's fob watch. Although attached to my waist band, rather than bouncing on my ample bosom.

OSCEs scare the bejeebers out of me.

Faith Walker said...

I really don't understand why you couldn't just wear a fob watch? Why is it inconvenient? And what "Procedures" is it not practical for? I wear one ALL the time, and I don't even own a normal watch anymore, so sometimes i attach it to my waistband or something!

I'm not impressed by many doctors/medical students reactions to the bare below the elbow thing- surely for the infection control issues it makes sense?
Miss bliss, I don't think its a case of looking ridiculous, surely what is best for the patients should come first and if that means tucking in your tie, well- do it.

As for alcohol gel- if it makes your hands flake off don't use it. Wash your hands after each patient contact. I'm allergic to the gel in one of the hospitals I work in and i have to do that.

There is also the question of how often you wash your tie? They must be teeming with bacteria!

Scrubs would just be better all round for doctors in my opinion! Would stop all the problem of them not wanting to comply with dress codes/infection control anyway.

Anyway, I have rambled enough!

the little medic said...

faith walker - I just disagree that not wearing wrist watches is going to make a big difference. I'll just wear my watch on my trousers in future.

My opinion is that if you're going to ban watches then its stupid to let people wear rings, even single gold bands. It is also stupid to allow doctors to use stethoscopes on every patient. I've only ever seen 1 doctor wash his stethoscope between patients. Every patient should have their own stethoscope, although that would cost too much!

I definitely agree with you about wearing the scrubs!

missbliss said...

Good God, how often do you wash your shirt? Your hair? Your face? You'd need to extend the latex suit to include a latex balaclava.

What about the hygiene of the patients? Maybe they should be pressure washed on entering the hospital.

I'm quite sold on TLM wearing a bow tie hehe.

DundeeMedStudent said...

It's all shite, personally. Why not let docs have a few white coats that the trust launder? then patients will know who is a doc/med student and who is hospital management.

dr_dyb said...

White coats do elevate patient BP bizarrely, a phenomenon my grandfather ( a nurse) noticed way back in the 1950's. bare below the elbow sounds ok, but my consultant won;t let us roll our sleeves up..... as we look unprofessional.

Fortunately, NHS Scotland has not yet implemented such a strategy, and is even using an alcohol gets with moisturiser in it!!

Interestingly the BBC News article on the matter included a great couple of quotes from an A+E consultant
He said: "Many doctors assume they can tell if somebody is sick just by feeling their pulse, and we were surprised to find this may not be the case."

He said: "If I was concerned about a patient I would use a machine to measure all these parameters formally."

A+E might have nice machines to measure pulse electronically, but general medical wards don't.

The DoH said "It does not prevent clinicians from doing their job. We would expect clinicians to use clocks to measure pulse rates as this is good clinical practice."

Right..... so every bay in a multiperson ward is now going to come complete with clock? After all we must have the curtains closed when conducting a patient examination. Or do Doctors carry their own clocks with them? Maybe on a strap, attached to a watch?

Nurses fob watches may, it appears be the way forward.

dr_dyb said...

The wedding ring issue is a minor one since many female NHS staff wear theirs on a necklace anyway due to frequent hand-washing etc, as do many surgery staff, so the males and medical staff will just have to catch up.

DundeeMedStudent said...

I was under the impression 'white coat' hypertension was just as evident when a doc takes the BP no matter what they are wearing, thus why my mother has been sent off by her GP with her own BP monitor and a diary.

As for NHS Scotland- ha, NHS Tayside are currently planning to do this, we have been told to prepare for going bear armed.

medstudentitis said...

We roll up the sleeves of our white coats as per hospital policy. I also wear my watch around my lanyard that holds my name badge. I would, however, suggest that hand washing is more important that bare arms.

Emma said...

I am in total agreement with Doctors wearing scrubs and even a white coat on top if necessary.

I must admit most of the ones I have come across would be quite happy too even the consultants to a degree, I have noticed you already have an Emma so I will sign off with

Emma H!x

PhD scientist said...

This dress code thing doesn't happen in many other countries in Europe.


Because the medical staff wear hospital-provided uniforms (and shoes!) that they change into on arrival and change out of before leaving. The uniforms are washed by the hospital.

Of course "it doesn't work like that" - the hospital has to have changing facilities for staff, and a laundry to do the washing. I am pretty sure most UK hospitals don't have their own laundries any more, and truck their dirty linen etc off-site to an outsourced provider.

However, doctors from Germany, who are used to the "staff uniform" system as I have described it above, are routinely astonished by the kerfuffles the Brits get into over dress codes.

The MSILF said...

Hmm, I vote scrubs. Probably never should have gone into a profession with dress codes, or people who get upset over them, though.

Just found your blog, I see that there is a whole world of med student bloggers I missed...looking forward to it.

DrShroom said...

I realise I'm coming late to this.
We're bare below the elbow, and in scrubs. I imagine this is the future, but am not keen. Pa Shroom managed perfectly well in a suit and tie, thanks v much, and his infection rate was below national average. (Howver he never did wear a wedding ring)

As for watches and pulses - I never wear a watch, and am quite happy that I can tell by feeling very slow, slow, normal, a bit fast really fast and oh shit. The exact number don't matter...