Dr John Garner: Hats off to nurses' headgear: they were uniformly good

Published on Monday 13 April 2009 19:29

I HAVE been reminiscing a little about my earlier career in hospital medicine and have been thinking about nurses in uniform.

The part of the uniforms I liked best were the hats. There were bonnets and caps, which came in all shapes and sizes, even flat-pack ones.

One of the features of this head attire was that it identified the nurse's position in the hierarchy. A plain white cap was a lowly beginner, and as you climbed up the career ladder you were given blue or green bands to show your seniority as a staff nurse. Finally on reaching the dizzy heights of ward sister, you disported a frill on your cap.

At the top of the tree was Matron, frills and lacy collar and cuffs with a bow under your chin – la Hattie Jacques.

Even when I left hospital and entered general practice, headgear was de rigeur. District nurses used to wear pillbox-type hats with big standard winter coats for the cold weather.

Of course times have changed. No longer are hats thought appropriate. Nursing managers have moved on to navy blue or black M&S style suits, while some nurses have lost uniforms altogether, for example psychiatric teams, midwives and health visitors.

All this nostalgia has been provoked by one of the latest Scottish Government's plans, to put doctors into uniform. I jest not. Working groups are beavering away, debating the very possibility. It is true that other health care workers do wear some sort of uniform, physiotherapists and other professions allied to medicine all have some identifiable garb. Even my administration and receptionist teams are kitted out in identical tops, so maybe it's not so daft.

One of the drivers for this proposal is the belief that a doctor's everyday clothes may harbour microbes of mass destruction and contribute to the problems of hospital acquired infections. Indeed, there is existing guidance that short sleeved shirts and no ties should be the dress of the day, though the scientific evidence for this is pretty shaky, so I'm told.

So, what would a Scottish doctor's uniform look like? One idea would be to put us all in theatre scrubs. Not very elegant, and although unisex it would be a trifle cold on a winter day in Dundee.

It would also be impossible to distinguish a doctor from all the other theatre staff similarly clad. I think patients would want something distinctive for doctors and indeed it would be helpful to identify the grade of doctor. Perhaps the Scottish Government should take a leaf out of the military – single stripe for the most junior of doctors, while a senior consultant would have several gold stars on his epaulettes and four bands on his jacket.

Then there's the question of who would design and make doctors' uniforms. I know some of my senior colleagues would want Saville Row, whilst the new young consultants might prefer an Armani creation. However, easy cleaning would be a necessity, given doctors' occasional encounter with sick, spit, and far worse.

There are practicalities to think about, like a spare for changing, additional shower facilities, laundry bills and so on. The costs seem to mount the more we explore this proposal. But what about other health staff not in uniform? Should we kit out our managers and administrative support staff in standard wear? Some sharp doctor, in the e-mail storm that this proposal has created, suggested orange boiler suits for the managers.

My real fear though, based on the old adage "what goes around comes around", is that the Scottish Government has got a secret plan to put hats on all Scottish doctors, perhaps with badges of rank – it couldn't possibly be true … could it?

&#149 Dr John Garner is a member of the British Medical Association's Scottish Council and is a practising GP.