Why 5 years at medical school cannot make you into Gregory House

by     5 Comments    Posted under: Career, Medical Schools

medical career satisfactionDoctors have a specific taste in medical dramas. Whilst most are happy to poke fun at casualty or scrubs, there are one or two fictional doctors that seem to earn an almost universal respect amongst doctors. The king amongst these characters for the moment at least, is House MD, ably played by Hugh Laurie.

What makes him so appealing to us doctors is his posession of talents that most medics secretly wish we had. Namely, his intellectual ability and knowledge combined with a flagrant disregard for hospital protocols and policies.

If you’re about to start medical school and harbour hopes of becoming an all knowing, all seeing, rule flouting medical genius think again.

Firstly, as a doctor entering a modern healthcare system you’ll find that the autonomy enjoyed by fictional medics simply doesn’t exist in reality. Todays real doctors have rules and protocols that govern just about every aspect of medical practice. Usually this makes good medical sense. For example the requirement to wash hands between patients, or to perform a rectal examination in suspected cauda equina syndrome.

More and more however, we have dubious regulations imposed upon us by people that have no idea about the way doctors work or the scientific basis for anything.

At one hospital I worked at, the x-ray department imposed a rule that the patients name must be written  twice on each form to prevent any repeat of an earlier error where the wrong patient was x-rayed uneccesarily. Although errors still ocurr on occasion, the rule is an immovable landmark that will scar every doctor that has worked there, and had requests for urgent x-rays repeatedly refused.

Another example is the decision over whether to wash hands, which is no longer left to an individual doctors discretion. I have personally been reprimanded by plain clothed undercover hygeine inspectors for not washing my hands after speaking to a patients relatives touching nothing but my own nose.

An old consultant general surgeon with decades of experience was told that he could not even see his patient from the end of the bed without first rolling up his sleeves and removing his wristwatch. His refusal to comply with such a baseless demand meant that a clinical incident was recorded against him by one of the nurses and he later found himself explaining himself to the chief executive of the hospital. He has now learned his lesson and has invested in some sleeveless shirts.

Any doctor who thinks too hard or questions the evidence behind these ever changing protocols will find that even their senior colleagues won’t back them for too long.

And this is what distinguishes the world of work from medical school. In the workplace the curious mind is seen as potentially dangerous. You must join the cult and accept the doctrine. Everybody that works in a hospital “knows” that MRSA is spread primarily by shirt sleeves and wristwatches. There is of course no evidence for this but no matter: the doctors who supposedly worry about evidence based practice are no longer in charge.

Ok, so not only is flouting rules out. Following many alternating and often meaningless rules is in.

So what about the other long held hope of the medical student?

You mean that of exercising ones intellectual muscle each working day? Well, if you’re hoping that after five years of med school you might possess the mental abilities and in depth pan-specialty knowledge of the likes of Gregory House, you can forget about that now.

On your first day in hospital medicine you will find yourself swamped with the sheer amount that there is to learn. The only relief is the realisation that as you ascend the ranks of seniority, your field of interest will get narrower and anything outside your immediate field will be referred to someone else with more experience. This happens at the most senior levels and the few doctors of yester-year that are lingering around with their years of wide and varied experience, find that involving colleagues from other specialties with specific expertise early on in patient care is mandatory, if only for the medico-legal protection this offers.

In summary the best you can hope for is depth of knowledge and experience, but in a narrow and ever narrowing field.  There is simply too much to know and too much at risk to begin offering opinions outside ones own focused area.

What about general practice then?

Well, this is seen perhaps by many as the last true retreat of the generalist with expertise across many areas. The modern GP however, is as much a specialist as anyone else. It’s more difficult to define the specialty, but perhaps it lies in managing vast numbers of chronic and non-serious conditions whilst keeping an eye open for the serious but rare and easily missed. A difficult job at the best of times, but with clearly defined boundaries and protocols.

So, if your attraction to a career in medicine lies in your admiration of medics in drama, that’s fine. Just make sure you appreciate the unglamorous reality too.

  • Dominique

    So damn right!
    Reality sucks.

    It’s amazing how many docs watch scrubs or House MD in the doctors mess whilst on-call. Pure escapism!

  • Lee

    I think some doctors really cannot be trusted to wash hands, or do the absolutely correct thing at all times.
    That’s why sometimes crazy rules must be imposed.

    COI: I worked as a nurse in a previous life and have seen infections caused by carelessness by both docs and nurses.

    • D Shaylor

      Lee, there is a major cultural difference here and it doesn’t surprise me to hear that from a nurse.

      Surely doctors are professionals and have enough knowledge about the pathogenesis of infection to decide what is best in each give situation. In terms of handwashing, sometimes there is no need as nothing has been touched etc, other times one might need some alcohol gel or to wash hands and there may be times when formal disinfection and a change of clothes etc may be required.

      One cannot expect a nurse to have any idea about this sort of thing as they are not trained to understand -inly to follow protocols.
      If we want our doctors to become simple rule followers we will deserve the crappy, over safe, under skilled medical workforce that results.

      • Leo

        Interesting to note that alot of these new changes, much loathed by doctors, have been decided upon largely by senior people in the nursing profession.

  • Jimbo

    Cool site.
    Is working in the US as frustrating as the UK?
    I think not. Better pay, and better status. Sounds like the NHS is for losers and managerial types.