The Hierarchy of Hospitals

It’s wonderful that when I meet people outside of medicine. For they actually think I know what I’m talking about, show interest in me with a genuine curiosity about life as a doctor, and well, make me feel like a human being. If only it was that way for those within the inner circle of medicine! For you see, within this inner circle exists a very clear hierarchy – and I, ladies and gentleman, am very much nestled someone near the bottom.

And on that note I would like to tell you one of the first gems of knowledge my junior doctors and I had imparted on us at the start of our surgical experience:

“Remember – shit rolls downhill…”

“Ah!” such fond memories and butterflies in the stomach…..

I joke for I actually had a pretty good time on surgery – I got to slice and dice, diagnose and treat a wide variety of conditions from children with acute appendicitis, to adults with cholecystitis, diverticulitis and acute pancreatitis. Surprisingly more information stuck in my brain than I realised during my 4 month surgical rotation as a junior doctor it seems. However, boy oh boy, is there a hierarchy!

Let me explain how this works. For each hospital team there are various layers. At the top is the consultant that runs that team. They are the top dog, the king pin, all seeing all knowing oracle that can do no wrong. They are feared, respected and revered all in one. Below them are the Registrars. Now this come in various grades – from the senior Registrars that are knocking on the door of becoming a Consultant to the more junior registrars that have more time to go. These are your middle-grade doctors who, as a junior are usually your point of call – they run the day to day show while the Consultant does more big-shot stuff. Don’t ask me what this big shot stuff is though (I’ll tell you in 10-15 years time if I ever make it that far along my career!). Now below them sits the senior house officers – “SHOs” as they are known. They act like the big brother or big sister for the bottom rung of the team – the House Officers i.e. Me. Why do I say it like that? Well simply because most of the day to day ward jobs and looking after moderately sick people are done by the House Officers -and the SHOs. So, when we, as house officers don’t know what to do – we go running to the cool head of the SHO. Much like a little brother or sister would do. Just to note too that is indeed how that trickles further up to i.e. when the SHO doesn’t know they go to the registrar – and when they don’t know the registrars run to the Consultant – usually in a hail of facts and figures about the patient and how they are on the brink of death unless the Consultant puts down their golf club or BMW magazine and comes straight away! Oh course I jest…it’s usually an Aston Martin mag….

So that’s it:

 Consultant -Senior Registrar –Registrar -Senior House Officer -House Officer/pond scum.

Oh and then there are of course the medical students too. But from my experience as a medical student, they may as well be a weak fart that people tend to shuffle away from. (note: as this is the case for medical students I do try my very hardest to be nice, helpful and teach them…but the fact is that being less than a year qualified myself, the emotional scars of my medical student experiences are still too raw to be around them!!)

Now as I said at the start of this – shit does truly roll downhill. Whenever something goes wrong it is usually the house officer’s fault. Amusingly this is the case even if we WERE on annual leave back in Essex (yes, me)! How we, as junior doctors, learn to deal with this is varied. Some of my junior doctor friends fight it until they are blue in the face, proclaiming their innocence until they are an exhausted heap on the floor of some operating floor after all the ranting and raving, moaning – and of course, wishing they were in a vet. I on the other hand do tend to just smile. I mean, come on, what’s the big deal – it’s done now – they’re just looking to offload the blame – so fine, no skin off my nose. In that way, it blows over in 5 minutes and we are all playmates again. Simple. Plus, I’ve wasted no energy in moaning (which, after-all, is not good for the soul!).

Does medicine need to have a hierarcy? Well, you know what, it probably does, yes. In a job where seniority and experience counts for a lot, we need to know whereabouts the person we are talking to sits on the ladder of importance. Without knowing that we could spend way too much time talking to someone far too junior – and in the blink of an eye and wasted time, the patient in question dies.

As I type this, I have finally finished my time on surgery. I hope you’ve enjoyed my thoughts on my time there. Next on the agenda is 4 months in Intensive Care. This will be another world full of technology, detailed human physiology and most likely a lot of cardiac arrests. Let the games begin..

Dr Nick


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