Tuesday, 27 November 2012

Medical Paramilitary

Sometimes I feel like when I signed up for medical school, I inadvertentently singed into a paramilitary force. These feelings are not helped by the fact that my boss back in Kenya would never tire of reminding me that " Medicine is like being in the military". I thought this was just a Kenyan thing until I arrived here. The 'paramilitary force' is even better defined and efficient. Now that I have close friends in the actual military, I think we can easily compare notes. In Medicine, there is a command line that is dictated by rank rather than age. The higher your medical education level, the higher your office. The Non commisioned officers are the medical students who are sometimes unruly due to being uninitiated and not knowing what to expect. They may therefore not follow orders appropriately or just simply ignore them. One can never rely on the medical student to carry out a task in the ward as they will not be held accountable for the consequences of their actions. However, gross misconduct can easily see them remain in that lowly rank for a considerable duration of time as they fail exam after exam despite reading very hard for it. The cadet is the intern. They do the bulk of the work in the paramilitary. They are expected to be responsible for everything that happens in the ward and inform the appropriate seniors as necessary. They will wake up at whatever hour to attend to whoever needs attention. They dare not complain about work load as this may see them stagnate in this position for some time. Thankfully, this stage is only for 1 year before you get promoted to a medical officer. Some people stagnate at this point and never progress. Interns come and pass them by to become consultants and come back to instruct their former teachers. Sometimes this can present quite an interesting scenario. After the medical officer comes the resident, senior resident, specialist, specialist consultant and if you are in academia will come the professor title. What, one may ask has prompted this discussion. The other day, I was invited by one of the consultants here to attend a 1 day workshop on a paediatric heart condition. The workshop is on a sarturday, it was going to take up the full day and I really did not feel like going. However, when, the consultant sent for me, I was warned to tread carefully as this particular person can be quite bad. I therefore feared to say "No" but instead committed to attend at least part of it. You see, the cardiology program here combines adult and paediatric cardiology and one is expected to be equally enthusiastic about both. This morning, the particular consultant announced in class that there would be a seminar and that the students should attend and lend a hand. This is one day notice and the next day was supposed to be a public holiday. I really felt sorry for the Residents as I saw some of them line up to give their excuses as to why they could not make it for the seminar. This brought back memories of the military where the rank is always right. When I talk to a senior ranking doctor, I call him 'Sir' and he may call me 'sir' but the difference is that I will mean it. When a senior doctor is wrong, we say he is old fashioned or I have a different opinion. In this place, this rank business goes a tard further. You should see the commotion that ensues when a senior doctor gets into the room and everyone struggles to get to their feet simultaneously. I always get caught out as I never seem to know what's happening.If a consultant is passing along the corridor and there happens to be a nursing station near the corridor, the nurses all stand up as he passes, like a standing ovation kind of thing. Never mind that he is minding his own business and may not even notice this ovation.... or maybe he does and just ignores it.... sometimes he may be gracious to motion to them to sit by a wave of the hand. If I am seated and a consultant comes and happens to pause near me, I spring up like a porcupine had just found its way into my seat. I guess thats our salute in this paramilitary, we stand up!

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