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.

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