** For the purposes of anonymity and confidentiality this interview has been fictionalised – no one real-life doctor corresponds to one character in the following piece. Rather, it is an amalgamation of views and statements from a number of healthcare professionals along with my own perceptions and ideas**
Grey’s Anatomy, Casualty, Scrubs, ER. This is a small selection from the catalogue of medical TV shows that expose the non-medical population to rare diseases, interior components of the body cavity, and an array of bodily fluids. Partnered with this and albeit less explicitly, we are also given a portrayal of the social dynamic between colleagues of different specialities and different grades inside a hospital. Commonly, the dynamic is such that those in the higher or highest ranks and perhaps glamourous specialties, such as neurosurgery, abase and degrade those beneath them. While we may naively accept and enjoy the humorous aspect to this - is this an accurate representation of the social structure within hospitals?
Tamsin informed me: “I think media often portrays there as being a dumb speciality and a smart speciality and I have always seen a lot of prejudice toward nurses on screen. But this is definitely not the case nowadays. There is no dumb speciality and no smart speciality and nurses are valued beyond belief. However, what I would say, is that every speciality has a reputation. For example, anaesthetists are known to be really good at maths - they have phenomenally hard exam questions“.
Upon my own research into hospital humour through doctor-specific Facebook pages and reading articles and blog posts by healthcare professionals, I unearthed a repertoire of generalisations and stereotypes. They were as follows: orthopaedic surgeons only care about bones and fixing breaks in them. Along with this, they like big drills and other medical toys, and were the archetypal 'rugby boy' in school. Next, there are the plastic surgeons who are portrayed as doing a bit of charity work but mostly do loads of breast implants on Harley street, earn loads of money and have nice holidays. Surgeons, especially neurosurgeons, love the praise, the 'thank you's', and the grand displays of gratitude. Paediatricians are all jazz hands and fun and are a native speakers of 'kid'. As Tamsin informed me, anaesthetists are the extreme brainboxes but are occasionally mocked for being able to sit down in the operating theatre. And lastly, there are A&E doctors who appear to live by the seat of their pants, pay all their bills late, and love chaos. Hence, while no speciality may be considered 'dumber' than others, there appears to be recurring generalisations attached to each speciality, which contribute extensively to the hospital dynamic.
Jacob explained to me that hierarchies typically relate to the grading system: those in grades F1 and F2 are fresh out of medical school, have no idea what they are doing, and are “just kind of winging it”. Next, is the SHO who has been a doctor for a few years, “can have a good go at things but if it starts getting complicated, they get a sweat on”. After this is the registrar who runs the hospital out of hours, has a very clear idea of what’s going on, is training for their exams, and is considered to be at the peak of their career. Lastly, you have the consultants who are fully qualified and have completed their exams. Jacob explained however that consultants are a little a bit less hands-on as they are not usually in the hospital out of hours, subsequently meaning they have less of an idea what’s going on “on the ground”. However, he was also clear to point out that the level of a consultant’s involvement varies for different specialities. For example, a paediatric consultant is on call out-of-hours and is mostly on the floor because “when there’s a sick kid… everyone wants the most senior doctor to be there”. Echoing Jacob's description, a meme about the grading system described consultants as being able to “talk with God“, whereas Junior registrars were described as being “occasionally addressed by God“. In the ranks below, Junior SHOs “pray a lot“, F1s “talk to walls“ and lastly medical students simply “mumble to themselves“. Thus, a doctor’s grade affects how they get perceived, received, and treated, especially in larger hospitals.
It is clear then that the humour is one of mockery, founded on the precept that everyone has been in every rank at one point - everyone has been a medical student, an F1, Junior SHO, and so on. More so, where media portrays certain specialities to be above others and nurses to be less than doctors, this is wholly inaccurate - all play a pivotal role in human healing and survival and are key to the functioning of a hospital. Hence, whilst this humour is one that can be belittling and deprecating, and sounds brusque and sardonic to those of us outside the medical sphere, mostly, it appears to foster a sense of inclusion and camaraderie - the humour is endemic to those in the medical community and understood only by them. Along with being a native language, this satirical communication is also essential: where doctors endure long shifts, are under extreme amounts of pressure, deal with emotionally challenging situations, and witness tragedies, this vernacular humour binds them together and acts as a coping mechanism. Importantly, this humour is also often the light that pulls them through the darkest of moments, allowing them to continue doing their job to the best of their ability. Perhaps Lord Byron’s adage applies perfectly - “always laugh when you can. It is cheap medicine”.