Time to put place based rivalry to restBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4774 (Published 13 November 2018) Cite this as: BMJ 2018;363:k4774
All rapid responses
Maskell discusses an important and relevant topic to all those involved in the medical field (1).
It is intriguing that the phenomenon of rivalry is instilled upon us even prior to beginning the path of becoming a doctor. Whilst applying for Medicine, students make an important decision of whether to sit the UKCAT (UK Clinical Aptitude Test), BMAT (BioMedical Admissions Test) or even both. This determines which medical schools they are eligible to apply for. From this first decision, there is a clear divide between those applying to Oxbridge and London medical schools and those applying to the “St Elsewhere” in the medical school world. There is a presumption that those applying to Oxbridge/London are superhumans, with an air of superiority. In reality, we’re all on the same page and as clueless about the application process, the human body and its intricacies as one another.
Whilst applying to medical school, I decided not to apply for Oxbridge/London medical schools. I was met with comments amongst my peers stating, “you can do so much better”; “you’re good enough for Oxford - why don’t you apply?”. However, I was as uncertain then as I am now what evidence those statements were based upon. Did Cardiff not have any patients to examine or take histories from? Was it not performing cutting-edge research or yielding publications? In retrospect, my medical school has offered a wide range of opportunities that are at par with those offered in other medical schools - and I have not been disadvantaged. Peers from across the country are often intimidated by the quality of research carried out at ‘top’ institutions. However, research offers a way of expression and inspiration from all healthcare professionals encompassing all backgrounds, and the site where it is undertaken should definitely not interfere whilst judging its academic rigour.
I am guilty of being instantly attentive and impressed when hearing about a Professor from a London University, even prior to hearing them speak or observing their research work. It is a knee jerk reaction. I recently intercalated at a London University, and my peers are instantly amazed by this - without questioning what degree I undertook, whether I passed this degree or even enjoyed it! However, in the real-world patients are more concerned about personal rapport with their doctor, and their clinician’s competence in diagnosis and management. This may be equally achieved in a district hospital in the Welsh valleys or in the heart of London. Location does not always equate quality, as it is often mistakenly thought.
It is counterproductive to exhaust our energy on battling peers at other institutions on the grounds of infrastructure and technological aptitude. Surely a better use of our time is to collaborate and integrate the strengths of neighbouring institutions within our own practice. This is beneficial as it not only allows prioritization of patient care but also creates a union between healthcare professionals, rather than hostility. During our careers, we are fortunate enough to experience life within a wide variety of institutions - and it seems the grass is always greener on the other side. In a recent article, Ridyard discusses the impact on parking charges on the morale of NHS workers (2). Car parking happens to be free in hospitals in Wales, however for others, the views of London from clinic windows may be more appealing. It is important to address that every “St Elsewhere” will have its own perks, and this does not warrant contempt but rather appreciation of each unique environment.
Sadly, it is unsurprising that the tradition of “St Elsewhere” has continued. The aim should be to impress the patients we care for with our knowledge and skills with the Ferrari acting as a tool, rather than a portal to promote envy amongst peers. After all, it should be remembered that knowledge knows no boundaries.
1. Maskell Giles. Time to put place based rivalry to rest. BMJ 2018;363:k4774
2. Ridyard Edward. Charging for hospital car parking risks demoralising the NHS workforce. BMJ 2018;363:k4529
Competing interests: No competing interests
Dr Maskell is right to call out place-based rivalry in medicine as ridiculous. It is even more ridiculous when it occurs among junior doctors, given that our current place of work is so frequently temporary and beyond our control.
Yet even so, you encounter FY1s who have never worked outside a teaching hospital holding it up as proof that they are somehow better than their colleagues. I know that because I think for the first two weeks I was that FY1. This is surely a defense mechanism. I've met many juniors who disparage training in teaching hospitals and the lack of familiarity and sense of belonging in larger organisations. When you're having a bad time, you'll take anything to make yourself feel better.
Rotating around gives you a chance to drive many different bangers or Ferraris. It's also a powerful reminder that your patients may have different measures of quality.While working in a regional centre I went to see a patient who had been transferred after a long stay in a local DGH. "How are we compared to your stay at St Elsewhere's?" I asked. "Everyone's very serious and your ice-cream's not as good " came the reply.
Competing interests: No competing interests