Thursday, 21 July 2011


Last week,  I had my first new-patient clinic since our Trust has decided to get serious about enforcement of the 'bare below the elbows' policy. New patient clinic is the one place where, as a consultant, one could or even should make the effort - patients expect it - you are the one they are entrusting their or their loved ones' fragile delicate lives to and you should therefore play the part - they expect to be impressed. A pin striped suit (2 or 3 piece) with appropriately  coloured (or white) shirt with French cuffs and serious cufflinks (not the ones in the illustration - they're for registrars!)
So, there I was,  in front of the wardrobe pondering on what to wear. Should I go in jeans and a sweat (as I sometimes do on operating days) and change into the scrubs (sans white coat off course!) Should I wear trousers, short sleeved white shirt and drab tie and look like a civil servant ?

Anyway, I came across this paper recently. It reports a fairly well constructed RCT and therefore represents fairly good evidence confirming that bugs on sleeves of a white coat (or expensive French cuffs ) are transferred FROM the skin within 4 hours - - i.e. the menagerie on your cuffs are a copy of the menagerie on your skin and not vice versa!

As Max Pemberton wrote in a recent article in the Daily Telegraph, it's all about bed occupancy and hand washing obviously.  Incidentally the article referred to the amusing intervention by an orthopaedic surgeon who during a visit by the Cameron, Clegg, Lansley roadshow to Guy's Hospital, made a very good point in an albeit pompous way.  As one can see in the photo, it was not just the cameramen who were transgressors -  Nick Clegg seems unsure of which part of his arm constitutes his elbow! ( I think there is a saying in the vernacular on the subject!)

Why do hospital management teams around the country insist on a meaningless non evidence based policy? It clearly is a top down directive the type of which I thought Andrew Lansley wanted to see gone. I would be very happy to see discipline being dished out to ensure hand washing (which works) - but ditch my cuff links?
Anyway, on the day, I chose the suit, long sleeved shirt with cufflinks, which, once in the office I divested to roll up my sleeves.
I can see that Cufflinks are going to join the long list of items such as pens and keys  that I have mislaid over the years!