social hierarchy in medicine - hate it

Have you noticed a similar social hierarchy in GP settings? Eg, are GPs condescending towards registrars/F2s/practice nurses?

Get out of London and everyone gets on.

Hi all, I'm almost a final year,

I understand that there is a necessary hierarchy in medicine. Obviously, the consultant has the most experience, hence takes the more complicated cases/has the most say - this is necessary. I really dislike the social hierarchy though. I hate how the juniors are treated with disrespect from some registrars, only to see that they are, in turn, disrespected by the consultants.

And, by disrespect, I don't mean being treated like rubbish. I mean just being rude. More rude than is acceptable in most other social situations. The condescension or the 'i'm not going to give you instructions, but you need to watch my every move to see when I choose to scrub even though I've sat here for 15 minutes doing nothing' or the 'you're a junior ... i look down to you' or the 'DO X, even though I haven't explained anything to you.'

I think it annoys me because I've tried to act as respectful as possible in my regular life. For example, I want to work with the homeless and I see how badly they're treated sometimes. We, healthcare professionals, are considered role models in many societies, but this can lead to arrogance, it appears.

And it's the social hierarchy that is the only aspect of clinical medicine that I detest. That being said, I'm not going to generalise (although over 50% of the people on my rotations are quite rude, it seems). It has been really bad in previous years (having been horribly yelled at for little reason etc.), but now the little things just seem so annoying. I just want to say didn't your parents teach you any manners? Also, in my experience, the majority of the nurses/non-doctors are awesome, it's often only the doctors who are just ... they really have no right to treat anyone with anything but respect (as we are taught to treat other human beings!)

Lol mini rant. Anyone felt the same way? How do get over it internally? I've got a pretty thick skin, so it doesn't affect me at work/hospital etc. And I'm very liked by most people I work with - I just have my inner conscience saying that it's wrong and I'm not the type to laugh at jokes that I do not find funny just so others like me/say things that I don't mean/start conversations with people who are rude to me to try and befriend them

What you're describing isn't an innate culture in the NHS or the medical profession (at least not anymore), it's something that's mostly confined to specific departments in specific trusts.

My theory is that the consultants have just seen thousands of medical students come along and just being clueless and have grown sick and tired of them. To be fair it's either them to blame for not advising the med student/junior doctor/registrar well enough or the education system not preparing

Have you noticed a similar social hierarchy in GP settings? Eg, are GPs condescending towards registrars/F2s/practice nurses?

It is unfortunately real and can really get you down. It's also a completely unnecessary way of doing things. And seems far more prevalent amongst certain specialties than others.

Developing a thick skin to it takes time - at first you might feel confused and spend a while trying to figure out what you've done "wrong". Eventually you might come to the conclusion that it's merely your presence as a student which is the "problem", which is truly bizarre since every doctor was a medical student once. Hopefully with time you will find it eventually bothers you less though, and then before you know it you're onto your next placement. That sounds like an awful thing to say as no one should have to get used to being treated like crap, but unfortunately I'm not sure how a single person would go about actively changing a working environment or people's ****ty attitudes which have become ingrained over a period of years and decades. Personally, I'd also avoid engaging any more than necessary with such individuals as they tend to get off on the power trip aspect of it all (this is clearly much easier to do as a student than a junior).

Just remember, it's not a reflection of you as a person or as a medic. You have people who love you and care about you - ********s in the workplace don't change that.

What I try to do is keep my annoyances in the back of my mind under the heading of "I will never treat my future students like this when I am in a position of responsibility". That can also be quite helpful.

Obviously people shouldn't be awful to you, but it does sound like you need to suck it up a little. Respect is earned, and a huge part of that is you treating people around you respectfully - regardless of your grade or title; do so and typically they will react accordingly and do the same to you.

Of course there's a hierarchy; there is in every job and every walk of life. You will have to just do what your bosses want for a while, that's the way of the world and it is, incidentally, how you learn to fit into your job. In most places, your bosses will (in my experience very) quickly learn to respect you for getting on with things instead of whining about how polite people may or may not seem to be, and will include you more and relax as you grow into your role as well.

Honestly, how you feel about helping the homeless or equality or whatever is irrelevant; it's not an egalitarian utopia - you're at the very bottom of an experience based pecking order, and while you should feel free to voice concerns about what happens and shouldn't take bullying or abuse from other staff, you shouldn't be such a delicate snowflake that every stern word sends you outraged to the internet.

I'm just gonna take a punt here and guess these experiences have been in London hospitals? My (admittedly brief) experiences down there i noticed a higher frequency of rudeness. Many friends who did SSCs/Elective stuff down there noticed the same.

I've never experienced a toxic environment like that anywhere across the Northern Deanery where i've worked/done placements. Sure you get the occasional brusque stand offish consultant or grumpy reg, but they've all been individuals inside a generally nice team.

What you're describing isn't an innate culture in the NHS or the medical profession (at least not anymore), it's something that's mostly confined to specific departments in specific trusts.

Same goes for this "gunner" culture i occasionally see mentioned on TSR about med students. It very much seems to be a culture confined to specific med schools, and honestly, the stories i've heard/read have always been coming from London schools as well.

To be honest, I always skipped GP rotations, so I don't know lool I've obviously been sometimes and it seems okay (but I guess it's because you're less in everyone's face?) I don't know, to be honest.

Obviously people shouldn't be awful to you, but it does sound like you need to suck it up a little. Respect is earned, and a huge part of that is you treating people around you respectfully - regardless of your grade or title; do so and typically they will react accordingly and do the same to you.

Wow, how do you get away with that? Seems like a serious breach in professionalism.

Similar to what navarre said to you.

Respect should be given to every colleague, patient and anybody else you meet - not earned. Why should you not be courteous & respectful to somebody you just met that morning?

This problem would not exist if everybody just respected everybody else. Clearly the OP is being respectful but certain people have not returned 'the favour'.

I'm just about to start clinical placements and you hear stories like from the OP. Everybody was a medical student (and junior) at some point. Nearly all of us aren't trying to be difficult....

And as Democracy said - this is the most important thing:

"What I try to do is keep my annoyances in the back of my mind under the heading of "I will never treat my future students like this when I am in a position of responsibility". That can also be quite helpful."

I've worked in fancy-pants tertiary centres in and out of London, as well as some pretty hectic DGHs, and certainly haven't found it to be a pervading culture in any particular place more than another. I think there are certain consultants, or perhaps certain departments, where it is an issue, but not everywhere. And I'm amazed that the OP has never encountered similar attitudes from nursing colleagues - they can cause no end of trouble both with doctors and within their own ranks.

No, it's not nice, and yes, everyone should be respectful, but you do have to learn to play the game a little in order to make your life a bit easier. I try to be polite to everyone, and certainly never shout, but some people and/or situations can really try your patience and so I may be blunt on occasion. On the other hand, a little politeness and interest goes a long way!

That's reassuring to know! And no, I only came across one scary nurse who seemed to never speak at a normal volume, but I was never really in direct contact with her. Maybe it's because the nurses on my last/current placement are awesome

I definitely understand your points. Maybe it was me just being unlucky? In one of my placement, the juniors and nurses despised some of the consultant (and reg) who had a 'reputation.' We were even warned by the head nurse/told to ignore her attitude. Again, I guess it's easier to recall the bad than the good! I'm very happy to hear that others have had more pleasant experiences in multiple hospitals and will try and look out for the positive!

Lastly, when you say 'certain departments,' do you mean stereotypes of certain specialities (e.g. 'sexist orthopods') or certain departments within specific hospitals?

I think it is more present in surgical specialties, but I meant specific departments in different hospitals, not all orthopods or whatever.

I think maybe you are unlucky, but being fed up of med students is probably more common if you're in big teaching hospitals where there are students everywhere.

I will keep all this mind - thank you. I have mostly been in big teaching hospitals, so that could play huge part too.