Bruno Rushforth on the roles we play

Bruno Rushforth It’s amazing how quickly one adapts. The first couple of days were a bit of a shock, but I soon accepted my fate and – rather worryingly – began to take on the role of the underling almost willingly.

I remember how the same thing happened when I’d started medical school. Having worked prior to medicine and thereby developed an identity and self-image as an independent “productive” citizen, it took a while to readjust to the role and expectations of being a student – being herded around and talked down to with depressing regularity.

And now here I was again. After a year as a GP registrar, with a fair amount of autonomy and self-reliance, and after six months of psychiatry, again with one’s own clinics and arm’s-length supervision, I was back in acute hospital medicine as a lowly junior.


At times it was like you weren’t even there, simply the odd request for a blood result or a telling off as the discharge summaries piled up. And with twice daily consultant ward rounds and omnipresent registrars, there was little encouragement to make any decisions for yourself.

It’s soon apparent that in the parallel world of paediatrics the hierarchy is shifted down one, such that the consultants act more like hands-on registrars, at times clerking patients and even taking blood; the registrars are the “SHOs,” running the acute admissions ward and coordinating the troops; and the “SHOs” are effectively the house officers, trailing behind on the ward round, notes flying as one arches to be involved as the seniors discuss patient management.

We mustn’t forget that – most importantly – this is great for patients: they have regular senior input and review. Indeed, one can’t help but think that this model will gradually spread across other specialties with patient safety issues gaining prominence and juniors’ working hours falling.

And there’s also something liberating at being relieved of responsibility, both as a junior and as a student. Starting medical school aged 27, I remember regressing to an unshaven, jeans and t-shirt clad, moody student demeanor, much to my wife’s amusement.

But there is a cost to all this: we need to encourage juniors to take on responsibility, appropriately supervised, or else we risk a generation of doctors obtaining their Certificate of Completion of Training (CCT) with limited clinical decision making experience.