Hektoen International

A Journal of Medical Humanities

The bow tie: For nerds only or necessary neckwear?

Howard Fischer
Uppsala, Sweden

Dr. Eric Kandel in a bow tie. Photo by Danielggpeters on Wikimedia. CC BY-SA 4.0

“You’ve been with the professors / and they all liked your looks…”
–Bob Dylan, “Ballad of a Thin Man”

The tie, whether the long necktie or the bow tie, is a piece of apparel without any real function. It is widely believed that in the late sixteenth century, Croatian mercenary soldiers tied a scarf around their necks to keep their shirts closed. The French upper class liked this style, called it cravate from the French croate (Croatian), and the necktie eventually became fashionable in the seventeenth and eighteenth centuries. In this article we will refer to the long necktie simply as “a tie,” to distinguish it from the bow tie.

Bow ties have been associated with lawyers, university professors, teachers, and politicians. Pediatricians also favor bow ties. The bow tie suggests that the wearer may have a “contrarian point of view,” and “wearing a bow tie is a way of broadcasting an aggressive lack of concern for what other people think.”1 The bow tie has become popular again,2 despite the opinion of men’s fashion advisor John T. Molloy in 2003 that, “If you wear a bow tie you will never be taken seriously…”3 It is also said that the bow tie is “not exactly sexy.”4 A survey of British outpatients found that 44% wanted their doctor to wear a tie, but very few wanted their doctor to wear a bow tie, which some found to be “a bit creepy.”5

Bow tie wearers who seemed to have been taken seriously include Winston Churchill, Franklin Roosevelt, Sigmund Freud, and US Surgeon General (1982–1989) Dr. C. Everett Koop.

This writer was told by a lawyer friend that wearing a bow tie when called for jury selection will almost guarantee that either the defense or the prosecuting attorney will excuse one from being a juror. A bow tie, in contrast to a necktie, will not get in your soup or caught in machinery. Pediatricians know the bow tie cannot be grabbed or pulled like a necktie, and that baby boys cannot hit it with a stream of urine.

In 2009, the US Centers for Disease Control and Prevention reported that 5% of people will acquire an infection during a healthcare visit. A study in 2014 for the Society for Healthcare Epidemiology of America advised that healthcare personnel be “bare below the elbow,” that is, wear short sleeves, no watches or jewelry, and also stop wearing ties. Sleeves and ties can transmit infectious agents from one patient to another.6 The UK National Health Service has required “bare below the elbow” and no ties since 2008.7

Could the bow tie solve the problem of transmission of germs by ties? A widely cited but tiny study (in which twelve physicians participated), had physicians wear the same long tie or bow tie for three consecutive workdays in an obstetric and gynecologic practice. On the first day, the long tie was more heavily contaminated by bacteria than the bow tie. However, on the third day there was no difference.8 It is difficult to conclude that this is definite evidence that the bow tie is just as guilty as the long tie. Wearing the same tie (long or bow) three days in a row is (hopefully) not usual.

This writer is a pediatrician who likes bow ties. Wearing a bow tie, I entered an exam room and found two brothers, aged three and eight years old, and their mother. As soon as the younger boy saw me, he started crying. His older brother explained to me, “He doesn’t like clowns.”


  1. “Bow tie.” Wikipedia.
  2. Elana Gordon. “The physician’s bow tie: Fashion statement or practical measure?” WHYY (radio), April 10, 2015. https://whyy.org/articles/the-physicians-bow-tie-fashion-statement-or-practical-measure/
  3. GQ.com. “Why a bow tie is not just for schmucks.” GQ, September 14, 2003. https://www.gq.com/story/bow-ties
  4. “Bow tie,” Wikipedia.
  5. James Henderson et al. “Bare below the …What do patients want their doctor to wear?” Ann R Coll Surg Engl (Suppl) 91, 2009.
  6. Andrew Frei. “Bow tie or no tie: A rule to reduce healthcare-acquired infections.” J Community Hosp Intern Med Perspect, 5(5), 2015
  7. Henderson et al, “Bare below the…”
  8. Marinko Biljan et al. “Multicentre randomised double blind crossover trial on contamination of conventional ties and bow ties in routine obstetric and gynaecological practice.” Brit Med J, 307(6919), 1993.

HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

Spring 2024



One response

  1. Absolutely fabulous and hilarious Dr. Fischer!

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