I'd like to go back in time and shoot the idiot that invented neckties. I hate 'em.
I have a Scottish doctor. He maintains his authority and professionalism by wearing a tie and long-sleeved shirts, but keeps on a long lab coat, buttoned up most of the way, so that little more than the knot of the tie is showing. The purpose of the lab coat for physicians is really to avoid having their clothes contaminated, anyway (in addition to showing who is boss).