Dr. John Ryan

It was 25 years ago that I began my internship at Virginia Mason Medical Center in Seattle. The dress code was essential. Outside of the operating room all surgical residents were to wear a dress shirt, a tie, and a white lab coat (interns coats were a different size than residents).

You could wear scrubs, but when seeing patients you had to wear a jacket – and if you were in clinic, there was no reason to wear scrubs, all of us needed to have a dress shirt with tie and the famous white jacket.

The program director, John A. Ryan, would walk by- straighten out my tie, “Looking good Simpson.” Never, never, never would it cross my mind to wear an open collared shirt.  Dr. Ryan clearly believed a meticulously dressed surgeon translated into meticulous surgery. For many things Dr. Ryan was our mentor, the one surgeon who demanded absolute operative perfection. He demanded precise surgery, careful handling of tissues, knowledge of the literature, and knowledge of anatomy. Seeing Dr. Ryan do the operation was like watching a textbook- the anatomy was clear and crisp. We all wanted to operate like he did. So we all dressed like him.

After surgical residency seeing surgeons who wore open collar shirts in Phoenix bothered me. They were not like Dr. Ryan!

Then the studies showed that neckties could be carriers for bad bugs, like MRSA, and others. More and more studies have shown an increasing colonization of neckties with pathogenic bacteria.

Legislators in New York are considering banning the necktie from all health care professionals.

Dr. Ryan, I still abide by your operative principles – but now, I wear scrubs almost all the time. They are clean, fresh and allow patients to know I am still a surgeon, but I just cannot wear the tie any longer. I knew Dr. Ryan would be wrong about something someday – just didn’t know it would take me 25 years to find out what it was.