Medicine · Rant

of hierarchy and apprenticeship in medicine


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.

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11 thoughts on “of hierarchy and apprenticeship in medicine

  1. Think of all the pleasure you’ll gain from taking it out on your lower underlings going forward..

    That’ll make it fair.

    Something very dangerous about letting students with no clinical experience treat….seriously.

    1. We don`t treat them, so to speak. We learn how to treat them. You really don`t think they`d let us practice whatever we wanted on whoever we wanted? That would be unethical. 😛

      And why do you always give evil ideas? I want to be NICE to my juniors, not carry on this ghastly trend 😛

      1. Tomato Tomaaato. And I wouldnt be surprised if they let you ‘treat them’ after all, learning on the job…okay. Wait that is messed up. It is medicine we’re talking about.

        haha, the road to hell were paved in good intentions. We’ll see when you are super senior, how you treat your underlings 😛

  2. Being nice is nice.
    Some people get that.

    Is is really a hierarchy? Isn’t that basically gaining experience and then being more knowledgeable at the end? I think that goes with almost everything, you learn and then you teach.

    1. It IS a hierarchy a.p. Of course, there’s the knowledge gained and then taught part too, but the system of respect and importance is clearly based on seniority. Which is kinda sucky for those on the bottom.

      1. Murtaza is evil dude. He made me drink coffee and rant incoherently on my blog. Of course it doesn’t take much to get me to rant. 😀

        Maybe all the meanies are trying to be all Dr. Cox on your rookie asses? Or Dr. Bailey if that’s what floats your boat? 😀

        1. Uh, Gray’s anatomy references? Wish i watched that 😛

          on second thoughts, not really. 😛

          Did he really? Heaven forbid 😛 Thats like the paki-blogger version of getting a girl drunk and dancing on the bar. For shame, Murtaza, for shame! i knew you were evil from the start.

  3. I watched 2 seasons of Grey’s, and then intermittently after that because all the drama just gets annoying after a while. 😀

    Yes, precisely, I couldn’t have said it better myself. He’s so evil man. Sob. We should’ve known. Creating havoc in the blogosphere, for shame Mr. Jafri. 😛

  4. hello, have been binge reading your blogs and feel like commenting on each one of them, i am in third year currently and i cant tell you how accurately youve described what i feels like to be in third year! i wished doctors were more considerate

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