The physician’s bow tie: fashion statement or practical measure?

What do modern medicine pioneer William Osler, neuropsychiatrist Eric Kandel and cult hero Doctor Who have in common? Well yes, they are all doctors (of sorts) … but more than that, they’re among a small yet pronounced cadre of physicians who’ve opted to wear bow ties.

“It’s a thing,” Farzad Mostashari, the nation’s former health IT czar, assures WHYY.

Trained in internal medicine, Mostashari, now 48, first started donning a bow tie in medical school, where he found inspiration from some of his bow-tie wearing role models.

Dr. Michael Levine, chief of endocrinology at the Children’s Hospital of Philadelphia, points out that bow ties bear a certain practicality, especially in pediatrics, compared to the traditional neck tie.

“It’s much more difficult for a baby to pee on your tie if it’s a bow tie,” he says.

Dr. Lawrence Kaplan, a general internist at Temple University Hospital, echoes that bow tie logic.

“I wear a stethoscope in my front pocket or around my neck, and the bow tie essentially doesn’t get in the way,” he says.

Some studies have found that neckties and other things dangling from the neck, like badges, can in fact be vectors for bacteria and even infection. Bow ties appear to be more hygienic, though movements are underway to get rid of neckwear altogether in medicine.

A brief bow tie history: “markers of privilege”

Historically, bow ties have been a marker of privilege, of “someone who takes pride in conservative men’s dressing and is very meticulous,” explains Russell Smith, author of Men’s Style: The Thinking Man’s Guide to Dress. The bow tie itself dates back to the 1600s, actually predating the neck tie. Initially, some men – most notably Croatian mercenaries – wrapped scarves around their necks to keep their shirts closed.

Bow ties gained its social status when Beau Brummell hit the scene in the late 1700s in England, according to Smith. Born a commoner, Brummell rose within the ranks of the wealthy, “yet was seen to be representative of democracy.” Like many during the time of the French Revolution, he deplored aristocratic styles. He preferred simple attire, with the exception of that scarf around his neck, which he’d sometimes take hours to tie in the way he wanted.

Smith says bow ties have since become associated with a connection to the past and to certain professions, whether that be medicine or even journalism, that have traditionally required going to an elite university.

For many African American men, the bow tie may also represent a more traditional form of fancy attire, he says.

Smith, who also wrote a fashion column in Canada’s The Globe and Mail for years, says bow ties have made a comeback in recent years, changing their context and meaning in society, depending on the wearer’s age.

“They’ve become part of the hipster uniform now,” he says, laughing. If he sees a young person wearing a bow tie, he has come to expect that person will most likely have a beard, and even working behind the barista counter preparing intricate coffee drinks.

Physicians weigh in

Dr. Harvey Rubin, 66, an infectious disease doctor at the University of Pennsylvania, can’t recall why he started wearing the bow tie, but it has certainly stuck.

“I like the way they look. They’re enigmatic. There’s no scientific reason,” he says, recalling the first time he ever wore one was at his own wedding. “It’s a skill that shouldn’t go to waste, I thought.”

For Dr. Kaplan, 56, an internal medicine doctor and head of inter-professional education at Temple University, the bow tie has turned into part of his identity, especially in the eyes of his students. He recalls attending a recent graduation, where more than half the medical class wore bow ties “and some of the women as well” in reference to him.

“I don’t like a lot of the formality that goes along with medicine,” he says, adding that he stood out at medical school as an older student. “There probably was an element that if I have to wear a tie, I’m going to be different.”

For Mostashari, whose bow tie has taken on a life of its own (literally. It has its own twitter account, though Mostashari claims to have no association with it), the accessory carries a deeper meaning.

 

Damn I look good. MT “@HealthcareWen: Dave, Robby, @Farzad_MD @KBDeSalvo @DavidBlumenthal #ONC2015 via @larrywolf51 pic.twitter.com/sLNOj1DFTA

— Farzad’s Bowtie (@FarzadsBowtie) February 3, 2015

 

“Partly for me, it’s the feeling of being a little bit of a misfit,” he says. “You don’t quite fit in the world. In a positive way. It’s a fun little expression of that.”

Dr. Levine at CHOP thought of his own bow-tie wearing heroes in medicine when first deciding to wear one. “I try to keep the tradition alive,” he says.

Levine has exclusively worn bow ties for over a decade, and he says more than anything, he wears it now because people expect him to wear it.

“When I come to work open collared, the first thing people say is ‘where’s your bow tie?'” he says. “It does set you apart.”

Alex Haynes, 39, started sporting bow ties 10 years ago as a surgical oncologist at Massachusetts General Hospital, which he says has rich history of bow tie-wearing physicians. During a fellowship at MD Anderson, he didn’t notice any doctors wearing them.

“It’s different and interesting,” he says, associating the bow tie in some ways with a certain quirky intellectualism.

But while bow ties might stand out, Haynes says don’t get the wrong idea – they’re in the minority. He estimates that about 5 of the 100-plus surgical faculty wear them at Mass General.

Regardless of age or specialty, Levine says one rule holds true for the great tradition of bow tie wearing doctors: You have to tie it yourself.

“If you buy a clip on, you can’t be a member,” he says.