Intended for healthcare professionals

Views And Reviews

Time to put place based rivalry to rest

BMJ 2018; 363 doi: (Published 13 November 2018) Cite this as: BMJ 2018;363:k4774
  1. Giles Maskell, radiologist
  1. Truro, UK
  1. gilesmaskell{at}

No one is, by definition, a better doctor because they work at a particular site

Nowadays remembered as the title of a 1980s US TV drama, when I was at medical school “St Elsewhere” was a disparaging term used to describe hospitals that we considered inferior to our own. That is to say, pretty much all other hospitals. One of the less savoury aspects of our not-so-hidden curriculum was a disdain bordering on contempt for those less fortunate individuals who worked or studied in places other than our own.

This was expressed in various ways. I remember being told that a particular patient had been assaulted twice, once by a man in a pub and the second time by the surgeons at “St Elsewhere” who had tried to finish him off.

Perhaps conversations like that still take place. We are all programmed to see the world in relative terms and maybe making disparaging comments about others provides a shortcut to boosting our own self esteem.

I met a consultant who decided to move from a teaching hospital to a post in a smaller rural hospital and was astonished to find that, within weeks, colleagues at the local specialist centre were starting to patronise him, when they had only recently been coming to him for advice. It seems that the respect we feel due to colleagues is in some irrational way connected with the place in which they work.

The lack of respect sometimes shown by staff in one hospital towards those in others carries echoes of the sometimes strained relations between doctors in primary and secondary care. Others have called out the strange phenomenon by which a newly qualified doctor can feel it right to take a superior tone with an experienced GP trying to make a referral for specialist advice.

Does it matter? Is this just a whinge from someone who works at the far end of a distant peninsula and has a corresponding chip on his shoulder? It matters because of current moves in many disciplines, including radiology, to encourage collaboration in networks. A network relies on mutual respect between parties to a much greater extent than a traditional hierarchical model of institution based care. Building that respect requires investment of time and effort—a lesson which should, by now, have been learnt from a number of difficult hospital trust mergers.

Having visited many hospitals over the past few years, the disparities in the physical environment, infrastructure, and resources available are often striking—you might look and feel pretty cool driving your Ferrari, but have a go in my old banger and see how you get on.

It’s surely time to put these pretensions to rest. No one is, by definition, a better doctor (or nurse or radiographer) simply because they work at a particular site. By all means let’s take pride in the institutions in which we work, but not by expressing demeaning and usually unwarranted opinions about colleagues in other places.

After all, you might think that you work in a world leading centre of excellence, but from where the rest of us stand it’s just . . . St Elsewhere.


  • Competing interests: None declared.

  • Not commissioned, not peer reviewed

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