COMMENTARY

Do Physicians' Beards Endanger Patients' Health? Should Personal Choices Be Limited?

Arthur L. Caplan, PhD

Disclosures

March 28, 2017

Hello. I am Art Caplan at NYU School of Medicine. I head the Division of Medical Ethics. How many of you have wondered whether you, or your colleague, should keep your beard?

There have been some publications recently that suggest that beards—even well-trimmed beards, beards that are washed every day—may harbor microbes and infection.[1] As we all know, there are lots of problems with infectious viruses, infectious microbes, and infectious bacteria in hospitals and nursing homes.

It has become a really tough personal-choice question. Should anybody—men who are physicians or, for that matter, nurses—have a beard? This is part of the bigger debate about whether doctors should wear ties because they get dirty and can touch the patient. Better to wear no tie or perhaps a bow tie, although I happen to be in a medical school that wants medical students to wear ties as part of their professionalism. Are we putting professionalism ahead of patient safety?

There are other issues. Are we washing our white coats enough to make sure that they are not becoming incubators of infectious disease? The issue about personal hygiene is tricky. Certainly, for people who have long hair and are going to be working in settings where there is blood exposure or surgery, we expect them to wear hair nets. We might expect people to wear beard nets. We might expect them to do what they can to protect the patient in the room from any type of infection that might occur because they are shedding viruses or bacteria.

On the other hand, whether any of these things work well in terms of protecting against viral contamination or against bacterial transmission is not really known. There are even some data that show that it is not really the beard, it is what is growing on your face; and whether you have a beard or not, some of those microbes can fall off of anybody's face. They are a source of contamination as well. Maybe we have got to get the Purell™ all over our bodies before we walk into some surgical or high-exposure setting.

I think the issue of whether or not you can wear a beard is personal. I think this is still not evidence-driven in the sense in which it is so bad a problem that we have to insist that everybody who has a beard should shave it. On the other hand, there has certainly got to be more and more attention paid to different routes of transmission, whether it is hand washing, white coats, ties, shoes, clothing, rings, or other sources of possible infection. You may be able to keep your beard now, but my hunch is that you better get ready down the road to shave it off if the data keep coming in to show that what you think of as perhaps an aesthetically pleasing or interesting appearance-enhancing cosmetic choice turns out to be a medical problem.

I am Art Caplan. I am at the Division of Medical Ethics at the NYU School of Medicine. Thank you for watching.

Talking Points: Do Physicians' Beards Endanger Patients' Health?

Issues to consider:

  • The National Health Service adopted a "bare below the elbows" (BBE) policy in the United Kingdom in 2008. The policy calls for short-sleeved lab coats, no wristwatches, no jewelry, and no neckties.[2]

  • Each year, an estimated 722,000 healthcare-associated infections occur in US hospitals, resulting in about 75,000 patient deaths.[3]

  • In 2014, the Society for Healthcare Epidemiology of America (SHEA) issued attire guidelines for healthcare workers in non-operating room settings in the United States. The guidelines favor a BBE policy, but they also note that when facilities and physicians choose to retain long-sleeved white coats, steps should be taken to reduce the potential for germ transmission.[4]

  • Many healthcare professionals object to BBE, noting that there is no indication that bare forearms are any more hygienic than sleeves.

  • Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.[5]

  • Some healthcare professionals worry that patients won't view them as professional if they don't wear a white coat.

  • On average, healthcare providers perform hand hygiene less than half of the times they should.[6]

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