Wearing ties on inpatient psych unit

[bunbury]

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Our program has a dress code mandating that male residents wear ties on all psychiatric rotations. This has become an issue of contention, as many of the residents feel unsafe wearing ties on the inpatient psych unit. I'd be interested to know if other programs force residents to wear ties on inpatient psychiatric units as a mandatory part of the male dress code.

 

[psychattending]

Our program has a dress code mandating that male residents wear ties on all psychiatric rotations. This has become an issue of contention, as many of the residents feel unsafe wearing ties on the inpatient psych unit. I'd be interested to know if other programs force residents to wear ties on inpatient psychiatric units as a mandatory part of the male dress code.

The expectation is that guys where ties on our inpatient unit.

 

[peppy]

One of the psych hospitals (with attached psych residency) I rotated at as a med student made a point of saying that ties were banned for safety reasons.

 

[DrBowtie]

Bowtie? 🙂

 

[billypilgrim37]

Some of our chiefs pride themselves on never having worn a tie through all of residency.

I will very likely start wearing them again during outpatient, because I like wearing ties, but ties are a safety hazard on an inpatient unit (depending on the acuity of the unit), and no resident should have to do anything they feel uncomfortable doing.

 

[IAmAUser]

.

 

[sideways]

Learn karate.

 

[michaelrack]

don't be a wimp

tuck the tie into your shirt, if you get scared.

 

[OldPsychDoc]

I prefer to keep my brain well-perfused, thank you.

 

[zenman]

I prefer to keep my brain well-perfused, thank you.

Reminds me of the paramedic who had a patient grab his tie up by the knot and then proceeded to have a grand mal seizure. His partner had a hell of a time cutting him out of that one in time.

I'd never wear a tie on an inpt psych unit. One thing I learned in MA is that the body goes where the head goes....

 

[CaMD]

Dudes in my program aren't supposed to wear ties on the locked wards. Not sure about voluntary wards. But I've seen very few ties this year at all, in any specialty.

 

[Messerschmitts]

Learn karate.

HA HA HA HA YES!!! 😀 Hiyah! 😛

 

[Regnvejr]

I haven't worn a tie since medical school. You will notice most psychiatry attendings (except those with jackets, like department heads etc.) are not wearing ties.

When I was in med school, the requirement was to wear a white coat, and look "professional." Psychiatry interpreted this as to not wear a tie. And even the white coat was frowned on in psych rotations.

After all, for an agitated, scared patient, a tie is an excellent hand-hold for pulling your head down to their knee. The psychotic ones are never the ones surprising you. After all, you are on guard with them. But the anxious, drunk PTSD patient in a flashback, you never see it coming.

And then, they have to be restrained, pumped full of Haldol etc. Therefore, your desire to wear a tie eventually ends up hurting them. So it is just fine to go without.

 

[heyjack70]

No ties on inpatient units unless you are quicker than the patients at all times. White coats should be worn in the psych emergency room if you want to minimize spit and vomit on your clothes.

*I notice that the emergency attendings always wear white coats, while rarely do the residents. It must be that youthful feeling of immortality.

 

[masterofmonkeys]

white coats and ties are notorious fomites. It's evidence-based medicine!

 

[whopper]

I advise against the use of ties. I've seen more than one occasion where the tie was used as a weapon. The patient squeezed the tie, choking the doctor.

On one occasion, even after the patient was separated from the doctor, the tie could not be loosened, and the doctor was suffocating as a result of reduced blood flow to his head. The staff had to quickly cut his $100 tie using scissors.

An attending once in the psychiatry crisis center where I did residency had a policy that he wanted no medical student or resident wearing a tie. Made sense to me. The crisis center was the place where patients were most likely to be acutely dangerous. There was little room in that center.

On the inpatient unit, we were not told we had to wear ties, but were encouraged to look professional. I wore ties on that unit, but whenever there was a code, I immediately took my tie off and put it in one of the drawers in the nurse's station.

I hope the programs that force residents to wear ties are very aware of this problem. If they still make the residents wear ties, they should at least tell them to buy a clip-on. This would suggest they are at least aware that ties can be used as a weapon.

if you ever actually feel unsafe then interview the pt with security staff present in a public area

Problem there is you sometimes don't know there's a danger until after the fact....

Learn karate.

I know this may have been in jest, but in several places, if you fight back, even in self defense, you can get in trouble. In several institutions, even if the patient attacked first, there are specific rules of engagement. E.g. some places, any action you take then must be to escape, not to fight back. Others, you can only respond with similar force.

 

[strangeglove]

Bowtie? 🙂

I would be more afraid wearing one of these; it could really make you a target of rage

 

[bama]

white coats and ties are notorious fomites. It's evidence-based medicine!

Actually, I don't think that there is good evidence based data that demonstrates that ties are....Either way, a clip-on counts, so its really a question of tolerating the loss of style associated with it. 🙂

 

[kugel]

A nurse friend of mine from years ago, Bob, was promoted to nurse manager and had to start wearing a tie. With each tie he owned, he put it on, cut the back of the neck, and sewed on a tiny Velcro patch. Now, if anyone grabs his tie, it comes off with only about 1 lb of force. Neat trick, kept the style of the better ties, and removed the choking hazard.

AND, he never had to tie one again.

 

[cleareyedguy]

I've never heard of anyone getting
grabbed by a tie. Violent, paranoid, intoxicated patients--who presumably do most of the grabbing--should be treated with respect and distance.

It probably depends on the region and hospital, but I wear ties as part of my professional uniform in order to assume a role as physician, and the tie speaks to my non-psychiatrist MD colleagues (who all wear ties), my outpatients (who generally wear ties since they too are professionals), and the inpatients (who may be wearing scrubs or pajamas but who need to see me as a physician).

I think most of professionalism is what you do rather than what you wear, but I do think we agree to lose a little individuality when we accept the benefits and responsibilities of being physicians.

 

[daru1]

No mandatory ties on our psych or non-psych rotations. 👍

 

[Doctor Bagel]

I've never heard of anyone getting
grabbed by a tie. Violent, paranoid, intoxicated patients--who presumably do most of the grabbing--should be treated with respect and distance.

It probably depends on the region and hospital, but I wear ties as part of my professional uniform in order to assume a role as physician, and the tie speaks to my non-psychiatrist MD colleagues (who all wear ties), my outpatients (who generally wear ties since they too are professionals), and the inpatients (who may be wearing scrubs or pajamas but who need to see me as a physician).

I think most of professionalism is what you do rather than what you wear, but I do think we agree to lose a little individuality when we accept the benefits and responsibilities of being physicians.

This is all very regional, though. Most doctors in my town don't wear ties, especially in the hospital, so not wearing a tie isn't just a psych thing. Most professional workers here don't wear ties, either. I know it's a different in the NE where people dress up more.

 

[la petite mort]

On one occasion, even after the patient was separated from the doctor, the tie could not be loosened, and the doctor was suffocating as a result of reduced blood flow to his head. The staff had to quickly cut his $100 tie using scissors

Let's start with, who wears a $100 tie around loonies? I've had to endure spitters while shadowing, and I imagine it gets much worse. If I were a dude, I'd wear ones from a $4.99 bin at Ross.

 

[la petite mort]

I would be more afraid wearing one of these; it could really make you a target of rage

This advice should be taken to heart, actually. You want to look as neutral and unnoteworthy as possible in that setting.

 

[Messerschmitts]

This advice should be taken to heart, actually. You want to look as neutral and unnoteworthy as possible in that setting.

I just wanted to say I love your screenname, ha ha. Very naughty and clever.

 

[whopper]

I think most of professionalism is what you do rather than what you wear, but I do think we agree to lose a little individuality when we accept the benefits and responsibilities of being physicians.

Very true and a point to consider counter to the argument against ties.

There are several studies showing that doctors lose credibility as expert witnesses depending on their dress. Resnick teaches in his review course on exactly what the expert-witness should wear (e.g. dark suits, dark or red ties, no silly patterns or cartoon characters on them, etc.). It did make a difference in studies.

 

[235750]

I agee with masterofmonkeys. Ties, white coats, and other formal wear should be banned from all hospitals, psych wards or not. They always pose a serious health hazard to us and our patients. We are behind the times in this area, even Scotland's with it.

 

[Psychelle]

I'm not sure if this issue has ever come up for discussion as a safety issue, but I know that at my hospital the administration really pushes the men to dress formally, including wearing ties.

Considering it's the South I have the feeling the powers-that-be would throw an absolute fit before letting the men give up ties.

 

[Sneezing]

There isn't anything wrong with a white coat. There is something wrong with how often we wash them. That's why we need to do away with the whole embroidered lab coat thing, and have the hospital launder them just like they do with scrubs. Pick one up when you enter the hospital and button it up. That would also solve the tie fomite issue on the floors, as your tie is snuggly pressed against you under your buttoned coat.

I'm still against ties and psychiatry. The possibility of violence is real and there is no need to hand an agitated/pyschotic patient more leverage against you. It should be a privilege of psychiatry to not wear a tie. Surgeons get to wear pajamas, psychiatrists don't have to wear ties - fair trade.

 

[Anasazi23]

Does this mean I have to put away the fish tie?

Very true and a point to consider counter to the argument against ties.

There are several studies showing that doctors lose credibility as expert witnesses depending on their dress. Resnick teaches in his review course on exactly what the expert-witness should wear (e.g. dark suits, dark or red ties, no silly patterns or cartoon characters on them, etc.). It did make a difference in studies.

 

[whopper]

I'm sure the fish tie will make you lose credibility, except maybe if you're a child psychiatrist?

There isn't anything wrong with a white coat. There is something wrong with how often we wash them.

Where I did residency, the hospital cleaned your white coats for free and the service was daily. IMHO the fomite issue would not be as much of an issue if the coats were washed at least daily.

 

[psychotrope]

One of the psych hospitals (with attached psych residency) I rotated at as a med student made a point of saying that ties were banned for safety reasons.

to me this never made any sense....I mean think about it. If some manic patient is trying to pull at your tie and choke you, he is totally exposed as his hands are useless.........

I figure if he is going for the tie, well....thats good because then that means he isn't using his hands agressively on me in other way and I can more easily diffuse the situation.....

 

[Psychelle]

That may actually be the ugliest tie I've ever seen. Which is saying a lot.

 

[tennreb]

Simple solution: wear a bowtie. You get professionalism without the safety hazard. In the South, bowties are still very much in style, and they are coming back in the Northeast.

Our medical center requires that all physicians wear ties at all times, except in the OR. However, this isn't strictly enforced. On our highly acute psych unit, no one wears a tie. Surgeons change out of scrubs and wear ties to clinic. In many hospitals in the South, surgeons are only allowed to wear scrubs in the OR and must change even when rounding on floor patients.

 

[Sneezing]

to me this never made any sense....I mean think about it. If some manic patient is trying to pull at your tie and choke you, he is totally exposed as his hands are useless.........

I figure if he is going for the tie, well....thats good because then that means he isn't using his hands agressively on me in other way and I can more easily diffuse the situation.....

It shouldn't even be an issue. Clip ons or none at all. This is the era of evidence based medicine. We have detailed out the lowering abilities of one statin from another. Honestly, I vote worker safety, and "an ounce of prevention is worth a pound of cure."

Secondly, in psych we aren't allowed to fight back or diffuse the situation as we please. We are physicians, mental health specialists, and these are patients. We are supposed to do minimal contact and the most evasion as possible. When some one has your carotids blocked off from the well tied ornately directed noose, you'll be out in seconds. Specific to your scenario, who says they will leave their arms out and extended? Is it not possible to pull down and drag your head to the ground? Or pull you in really close where it is harder to freely move your own hands around?

Whoever it is that makes the decision should have a testing session where they get choked by their own tie and see if they feel the professionalism is still worth more than the physician safety.