Medicine is like a hierarchy. I don’t know if its like this in other jobs or sectors, but I’m guessing some sort of similar system prevails everywhere.
At the top are the consultants. They are supreme in their position, or at least so it seems to us, because we have no contact with anyone else higher than them. So at the top are the consultants. Then come the residents – with egos respective to their seniority. The interns are next – poor fresh doctors and the workhorses of the pack. Phase three students – fifth years – are the next in line. And then and only then do we come in – poor phase one students, with the ink still wet on our second-year marksheets.
As Ammar – our group leader – remarked gloomily after a third haranguing from an irritated resident on a particularly gloomy day – we, my friends, are at the bottom of the food chain.
So when the consultants are annoyed, they take it out on the residents, who take it out on the interns, who take it out on either us or the phase threes. That’s not to say that phase threes or consultants or residents can’t take out their anger directly on us too – the principle being that when you’re at the bottom of the food chain, everyone takes a bite now and then.
What annoys me is that these people should technically be much more considerate. Even in tough and competitive rotations, they should understand. We’ve had almost zero previous clinical experience. As far as dealing with patients is concerned, we know about as much as an engineering student knows. We don’t know what tests we’re meant to order, or whether to check the patient’s pulse first or his temperature. We don’t know how to diagnose conditions on sight. We can’t take a patient’s relevant history and perform a relevant examination all in the space of a few minutes.
Medicine is an apprenticeship. The first two years are just to stuff you with knowledge – after that, for the next three years all the practical knowledge is passed down by example and by practise from those that already possess it to those that do not. We, as apprentices, are meant to watch and learn. What this means in essence is that the consultants smiling at the clumsy way we try to examine patients, or the residents passing snide comments when we don’t know why they’ve placed a nasogastric tube, are completely unjustified in doing so – because not very long ago they were in our place. Just as confused, just as clueless, just as fresh and wet-behind-the-ears. And thus they should understand how we feel and help us accordingly.
Of course, I’m not trying to paint all residents as malicious and all consultants as unkind. Good consultants and encouraging residents are just about the only reason why we manage to survive three years of this torture. But it just so happens that in some rotations and in some disciplines the number of nice seniors is outweighed by the number of nasty ones, who think that now they’ve reached a certain point in the hierarchy they can openly insult or bully the ones on levels lower than them.
This is the height of unfairness, and a practice that I think should change. The only way to do that, of course, is to inch our way up there without completely forgetting all this 😛
Meh. Fat chance.