Medical Hierarchy

Everyone in the medical field knows that there is a hierarchy in medicine. Those who are outside of the field of medicine may or may not have any idea. This is evidenced by experiences in the emergency room. When I was a kid and went to the ER, I had know idea that the guy in the white coat might have been fresh out of medical school, but not everyone is as blissfully ignorant as I was--I've heard many patients immediately ask for the "real doctor" (They must be frequent visitors to the ER).

But for those in the medical profession, there are countless points at which you are forced to realize exactly where you are on the totem pole. There are obvious things such as the ability or lack thereof of signing off a note on a patients chart. For medical students this means writing out what you think is a good note, then finding a doctor who will check it and sign at the bottom.

Aside from the more obvious things, there are a litany of lesser things by which people are kept in check. I would argue that whether they are intentional or not, they serve as an important check in keeping one from becoming too full of themselves or feeling that they had "arrived" and no longer needed to study.

One of the more commonly referenced is coat length. For those not indoctrinated, the white coat of a medical student only goes to the waist (if that), while the coat of an actual doctor (resident or attending physician) goes all the way to the knee. But I think that the hierarchy can be much more subtle, and even though it is not always recognized as such, those that step outside of it are punished in just as subtle of ways.

For the gunners, although people may tolerate them to their face, I would be surprised if anyone would go out of their way to help them. Say for instance someone knew of a chance to meet with several higher ups in the surgical world, I don't think that the first thing you would do is call them up to let them know about it. If someone wants to be a gunner to the point that everyone can see they're looking out for number 1, people will consciously or unconsciously punish them for it.

Although I personally can't speak to this, I've heard that the same principles apply to medical students on rotations. Don't make the residents look bad. It seems pretty straightforward, but I guess some people were never properly trained in the social graces. (bunny trail: a lot of people say things like "I just need to get past the basic science and start clinical rotations, then I'll really shine"--we can't all be right can we). I wouldn't have said a word when was at the Morbidity and Mortality conference, I don't care if they pointed at me and asked what my name was, I would have hoped someone else would have answered. Real or imagined, I've got a healthy (I think) fear of being blackballed.

Lastly I think there is an even more subtle component. Next time you are in a room, look at the seating arrangement. Say for instance you are in a room with a chair a couch and hardwood floors. I would venture to say that 9 out of 10 times, the most senior doctor will be in the chair, the three residents will be on the couch, and the medical student will be on the floor.