A junior doctor by any other nameBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4797 (Published 17 October 2017) Cite this as: BMJ 2017;359:j4797
All rapid responses
'SHO, let it go!' That is the slogan used in one of my workplaces. It is meant to refrain trainees from using the term 'senior house officer (SHO)' because the NHS moved away from this term years ago. It is also meant to help core trainees to be differentiated from foundation year 2 doctors, and be recognised for their ranks in the workplace. The current proposed campaign serves a similar purpose, in which the term 'junior doctors' is suggested to be changed to give trainees the 'respect they deserve.'<1> Similarly, general practitioners have proposed changing their title to 'primary care consultants' to earn more respect from their peers.<2>
But does it matter? How would these proposed changes positively impact on teamwork and patient care?
As an analogy, am I undermining a consultant surgeon if I call him Mr. rather than Dr.? Does it mean I am discrediting my colleague's years of training if I call him by his first name rather than his title?
"Hello, this is Dr. John Smith, MBChB, PhD, intercalated BSc, MRCP, ST5 on the phone." What impact does that make? Other than adding comic relief to the conversation, I do not see any obvious advantages.
The real problem is not your title - it is how your colleagues do not try to know you and understand your abilities. In some instances, seniors do not even bother to know the names of their juniors. It is very prejudicial to assume the juniors, who may have fresh knowledge from medical schools, cannot contribute much to a healthcare team. Even for new graduates, some may have various experiences in the past which are useful. I know a medical colleague who used to work as police officer and can tell me the services available for domestic violence victims. I have colleagues who used to work as allied health professionals and can teach me other aspects of healthcare. Despite being very junior in their medical careers, they are all valuable members of the team.
Perhaps, the NHS work culture focuses too much on hierarchy. When a junior referred a patient to another team senior, the senior's first question is not always about the patient - rather, it could be 'what is your grade?' I remember once at work a surgical consultant was laughing at how a surgical registrar needed advice from an anaesthetics core trainee regarding the pre-operative management of a patient. I do not see the humour in this case, as I believe anaethetists are probably one of the most knowledgeable experts in pre-operative management. Even if this core trainee struggled, he would be the best person to escalate to the anaesthesia team seniors.
I understand the point of name changing is to improve trainees' self-esteem. However, even if we officially change the names of 'GPs' and 'junior doctors', someone will still inadvertently use these terms, similar to what we have done with the term SHO. The real underlying problem is not the name itself - it is people's over-focus on hierarchy, tunnel vision on teamwork, lack of mutual respect, and prejudice of other team members' abilities. In a patient-centred model, patients are the real leaders. We, juniors or consultants, should remain modest and see ourselves as 'public servants for patients' health.'
1. Baddeley R. A junior doctor by any other name. BMJ. 2017;359:j4797.
2. Wass V, Gregory S. Not 'just' a GP: a call for action. Br J Gen Pract. 2017;67(657):148-149.
Competing interests: No competing interests