Sifting way back into the history of medical training, I think there has always been a hierarchy in medical school that I like to call “the totem pole.” This medical school hierarchy is something that really pisses me off. It’s kind of like your average office/place of employment ranking system, except that you’re getting paid to be at your job and you have no reason to complain about it. I’m paying for this shit so I can bitch all I want.
So what exactly is the totem poll? It’s a method of how things work on the wards, and it goes like this (ranked from shit-eating lows to gimme-a-blowjob-because-I’m-God high):
Medical Student – Lowest of the low on the totem pole. Pays tuition so that he or she can make copies, fetch food, pick up the intern’s dry cleaning, get vital signs on patients for the residents, and to bring in articles from scholarly journals on some “interesting” topic that nobody really gives a fuck about anyway.
Nurse - Not much better than the medical student, but they get paid so they rank higher. They frequently clean up misplaced excrement, sample stale urine, and regularly come into contact with bodily fluids known to contain easily-transmissable diseases.
Intern - Fresh out of school and scutting like a begger. They pretend to like 16-hour shifts and fake happiness while having no life outside of their work. In fact, some take pride in this. It is pretty well known within the medical training ranks that if you appear depressed, overworked, or otherwise unhappy that this will not bode well for your evaluation at the end of your rotation. For this reason, many residents ignore any symptoms of depression and very often their personal lives suffer. It’s no wonder that male physician suicide rates are 40% higher than the normal population.
Resident - You are called a “resident” after you finish your intern year. Depending on your specialty, you may be a resident from 2 to 5 or more years. The ranking is obvious: the more time you’ve been a resident, the higher you rank on the totem pole. Since you are actually taught to believe that “the shit runs downhill”, your life gets moderately better the higher you are ranked.
Fellow - Those few that love punishment. Residency wasn’t enough hell for these guys, so they’ve decided to specialize in their chosen field and complete an additional year or three of medical training.
Attending - Ah, the top of the totem poll. These guys think they are walking gods. They love to pimp medical students on bullshit facts that they had to look up the night before. Look why surgeons love me so much:
Attending: “What artery are we tying off right now?”
Me: “I dunno.”
Attending: “You took anatomy didn’t you?”
Me: “Yeah.”
Attending: “What are you going into?”
Me: “Not surgery.”
Attending: “So what artery are we tying off right now?”
Me: “I dunno.”
Most stay in academic medicine not because they enjoy teaching, but because their personality is not at all conducive to a private practice. In fact, I know of one attending that can name the top 20 reasons why he hates the training hospital where he works. Why doesn’t he leave, you ask? Simple, it’s because he’s an asshole to everyone he comes into contact with and he’d be thrown out on his ass faster than a two-dollar whore should he attempt private practice.
Here’s how it goes down: medical student reports to nurse or intern, intern reports to resident, resident reports to attending. If you disturb this hierarchy in any way – such as by not being able to find the resident and reporting your problem directly to the attending – you most likely will hear about it the next day.
The sad thing is that all of the goody-goody residents and gunner medical students think the totem poll is the best thing since sliced bread. After all, they want their “exceeding expectations” evaluation and that big shiny “A” on the rotation.
Fuck it, gimme my C. I’m not kissing anybody’s ornery ass for a grade.
Until next time, peace out.
Screw the totem pole…why not just go straight to the attending vs following the hierarchy? Who cares about protocol anyway. Fuck ‘em if they can’t take a joke!
well anonymous, it isn’t that simple since most medical students actually want to practice medicine in a field of their choice, and thus pissed off attendings taking it out on their resident (the guy you’re supposed to be reporting to) makes for bad grades. Of course the OP doesn’t give a shit about grades, but those who want to have that nice life after residency may want to match into nice lifestyle residencies, and while I agree the totem pole bullshit is a load, its really not any different than any other business, same bullshit no matter the industry, just most medical students are so caught up in dumb ass bullshit that they can’t see medicine for what it is, a job like any other. Not to mention the physicians that work in academic medicine have nothing but ego to go after cause they’re salaried, so they gotta get their kicks out of something, mostly pimping from what I hear. so their nuts can be oh so big when sucked on by menial medical student/intern, sad really
You kick ass!
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Nothing different from any other profession. All occupations and all societies have a hierarchy and each has its own rules. You discover them, you follow them, you rise in that organization. Disrupt the chain and the guy with hurt balls tries to kick you back. Simple.
The hierachy order is ok. I’m a Medical Student and can’t wait to get up the organization!! As far as I’m concerned, those up there have earned the honour.
I agree with Alex, there has to be structural order.
Alex and Uta, are you guys saying that it’s okay for med students to be abused so they can become attendings and then abuse med students? Friend, this is a vicious cycle that should be broken, not a necessary “structural order”. Hierarchy my arse man – if you want to be abused by your superiors go join the army.
i love you.
i love you. “Simple, it’s because he’s an asshole to everyone he comes into contact with and he’d be thrown out on his ass faster than a two-dollar whore should he attempt private practice.” I’ll remember this when i’m treated like crap tomorrow, and it’ll make me feel better.
alex is a gunner. or atleast a gunner sympathizer.
Hang in there, it gets better. Some residencies are notorious for being cruel (surgery, OB), but go through with it if thats your passion b/c you can change the environment for the next generation. I’ve found that the confident, smart surgeons are the nicest, where as the insecure are really cruel. Bless them b/c they’re just trying to make it.
If you hate med school so much why are you doing it? One of my attendings told me this (not to me but about people like you apparently) the other day and I totally agree with him “If you don’t like what you are doing, do everyone a favor and go do something else.” Maybe this is all parody and I hope it is, but if it isn’t I hope for all of your future patients’ sake that you find something in medicine you love and are passionate enough about to effectively help your patients.
Wow….screw this hierarchy nonsense.
Too bad me, and other RNs, have saved plenty of residents from a royal fuck-up. A recent conversation:
“No, Doctor, Normal saline is NOT the same has half-normal”
The excrement we clean up does not always come out of our patient’s asses.
“