A guide to medical etiquette: the old guard

The old practice of ritual humiliation endures even today, in a medical world of ethics committees, higher education funding councils and clinical audit.

Some of the old guard still parade the wards, looking for new recruits to badger, so here is some advice about how to conduct yourself when one such as this comes your way.

You must know your anatomy. However, I don't mean the the relevant sort of anatomy that is emphasised in the new courses. No, instead you should learn obscure nerve roots and peculiarly named organ parts. Similarly, with diseases, it is no use knowing all about coronary heart disease if you aren't familiar with Veinhower's syndrome.

Of course, there are shortcuts. You can get out of not knowing most of the anatomy by lambasting the new curriculum that your medical school has adopted. There are likely to have been some changes since your tormentor graduated and, to such a one, all change is bad, and likely to be responsible for your lack of knowledge. When it comes to the syndromes, why not make them up? After all, most of them are simply due to the chance concurrence of discrete diseases (most of the eponymous anaemia syndromes fall into this category).

The absolute key, however, to escape from grilling is to provoke nostalgia in the elderly fellow. Adapt the following generic phrases to your local situation.

"Wasn't INSERT DISCOVERY (eg, x-ray) invented here?"

"Were you involved with Professor INSERT NAME's discovery of the treatment of INSERT NAME?"

Another pitfall is to use "a vulgar Americanism" (as one cardiologist put it to me). Never say dilation, always dilatation, and pity any student who dares to say epinephrine.

Despite these problems, teaching from the old guard has its advantages. They have unrivalled experience of medicine. This experience can temper the constant quest for technological advances that dominates modern medical thinking.

Therefore, simply adopt the conventions of their time and you will find it a useful (if daunting) experience. However, at all times beware the paternalistic approach to patients shared by the old guard.

David McAllister, intercalated medical student, Glasgow University
Email: 960715m@student.gla.ac.uk


studentBMJ 2000;08:217-258 July ISSN 0966-6494