What was John’s time at medical school like?
What kind of courses would he have taken?
What do medical students actually do?
In this meta I explore John’s life at university and I draw on my own experiences as a medical student to provide a short resource for anyone who is interested in John’s earlier life or writing fanfiction concerning the subject.
- The structure of medical courses in the UK
- The subjects that John would have studied
- The joys of dissecting a cadaver
- How going to medical school helps John in crime solving
Crossing the Rubicon
Medicine is a very competitive subject to study at university. The UK government has strict quotas on the numbers of students entering medical school because training a future doctor is a very expensive endeavour. Today it costs over £250,000 pounds to turn a medical student from a bright-eyed fresher to a fully qualified doctor.
When John went to university there were no tuition fees, his entire education was paid for by the state. University education in the UK is still almost completely state sponsored. There are very few private universities. The famous UK institutions like Oxford, Cambridge, Imperial College etc are all government funded.
Getting into medical school is not an easy feat. It requires very good grades at A-level (the exams pupils take at age 18) and medical schools interview their applicants. Most likely, John studied three A-levels in Biology, Chemistry and Physics but many students do choose a combination of arts and sciences. He would have to get at least AAB or perhaps AAA to enter medical school.
Medical courses in the UK are a minimum of five years long because you can go straight into a medical course after leaving school. It is not like the American system where you have to have an undergrad degree first. Once you graduate – you become a fully qualified doctor.
Side Note – Keeping it in the Family
Several people have suggested that John became a doctor because his father was a doctor or something else to that effect. This is not an invalid assumption – a significant minority of pupils in my year at medical school have a relative in some branch of medicine. However this still means the majority of students are the first people in their family to start a career in healthcare.
I personally think that suggesting students go into medicine simply because their parent(s) did so is doing a lot of inspirational future doctors a great disservice. This assumption also fosters the misguided idea that people without personal connections in medicine are at a disadvantage. This attitude is something that puts many students with diverse family backgrounds off from applying to medical school.
How to make Friends with a Skeleton and Other Important Skills
My course is a very traditional one that has separate theoretical and clinical components. It is probably a good reflection of John’s experiences at medical school during the 1990s.
In the first two years John would have seen few if any patients and probably spent most of his time in lectures and science practicals.
In my first year we studied: anatomy, physiology, histology and biochemistry. Each subject was taught through a combination of lectures and practicals.
I remember in fresher’s week, still dizzy from the around of parties and nights out, all the medics in my college were summoned to the Director of Studies office. There we were each issued a box of bones: literally a shoe box containing an assorted jumble of human remains like a bizarre, morbid kind of pick and mix.
In the months that followed I realised I had the bones of at least five different people rattling around in my shoe box. It was impossible to assemble any kind of coherent skeleton anyway; given I had three arms, no femurs and a jaw bone that didn’t fit the rest of the skull. The bones lived under my bed for a year and in a strange kind of way I became very attached to the (possibly) five people I was in essence sharing a room with. It’s incredibly sad that their earthly remains are stashed in a shoe box but I hoped and I still hope that they wanted to donate their bodies to medical science.
Although I found peace with my bones – I never got used to my cadaver.
Throughout the year each small anatomy group (about 5 people) systemically dissected their own cadaver during these practical sessions. I vividly remember the disgusting smell of formaldehyde that penetrated the entire anatomy department and the huge hall containing row upon row of dead bodies laid out on metal trolleys. Once you got used to smell, the worst thing became the fat. Even tiny little old ladies have unimaginably large amounts of fat that to be scraped away by the handful in order to expose the muscles, nerves and arteries underneath. Our gloves were permanently covered in a shiny, slimy sheen of melted human fat.
What I found most disturbing were the bits that would inevitably end up sticking on my lab coat at the end of each session: little yellow globules of fat, fascia and unidentifiable tissue. We had to systemically put every single tiny part of human tissue that was removed in a plastic bucket so that the person could be buried “whole”. Sometimes it didn’t work, particularly on one unfortunate day when a member of our dissection group accidently got a piece of fascia (the connective tissue that lines human muscle) in her mouth and reflexively swallowed it. I was convinced she would get ill but she was completely fine though very queasy for several days.
At the end of the year there was a touching ceremony where the relatives of the people who had donated their bodies came to meet to students who had basically spent a year dissecting their grandma/grandpa. The mass “funeral service” contained the most awkward conversations I’ve ever experienced but it was also very important for me to recognize the generosity of the deceased who donated their bodies to help us become better doctors in the future.
Human dissection is not very common today – in fact I think my medical school is the only one that still runs this type of course. However when John was at medical school, having your own skeleton and dissecting your own cadaver was still seen as a bastion of medical science. I do hope he enjoyed it more than I did.
Physiology was less “interesting” as subject, though we did have fun suffocating each other in the hypoxia experiment which demonstrates that it is the level of carbon dioxide in your blood which produces the main stimulus for your to hyperventilate/feel breathless.
Biochemistry consisted most of learning large amounts of facts about the structure of cells, their signalling pathways and the body’s metabolism. I found it interesting because it finally answered my question of why eating sugar makes you fat, and why losing weight is so difficult.
In second year there was neurophysiology, pathology, human reproduction, and pharmacology.
My first hour alone with my very own pickled brain in a bucket was something of a disaster. I dropped the brain several times on the floor and furtively wiped it down each time with my lab coat in the hopes that no one would notice the dust stuck to the underside of my external brain. Sentiment entered the equation very early on, and I named my brain Herman because the size suggested it probably came from a man (given how much time I spent with the brain, I had to call it something). Herman had no distinguishing anatomical features but he got me through my exams all the same.
Pathology practicals revolved around petri dishes filled with pathogenic bacteria. They often turned into long tedious sessions of guess the germ and frankly I thought all bacteria colonies looked pretty much the same. The boys sitting opposite to me on the lab bench thought so too, which is probably why they developed a habit of scooping out the bacteria and flicking it at my face for entertainment.
At first it was just annoying until one particular clump of bacteria landed in my eye. I might not have minded had the session not been on STDs. So halfway through the practical, the entire lab fell silent when I screamed: “I’ve got syphilis in my eye!”
It turned out I had failed to correctly identify the bacteria: I in fact had gonorrhoea in my eye.
Fortunately the bacteria were non-disease causing mutants, but I had a lot of explaining to do when word spread that I had contracted an STD through my eye.
The World's Most Over-Glorified Apprenticeship
Science and theory is very important but the first two years do not actually teach you anything useful regarding how to be a doctor. This is what the next three years of clinical experience are for.
Generally medical students are dispatched to hospitals were they shadow the doctors in a sort of poorly organised unofficial apprenticeship. The regimented timetables of lectures and practices gives way to a much more aimless nine to five working day. Instead of intense periods of study, I often find myself hanging around hoping that someone might notice me and teach me something.
Usually each medical student is assigned to a ward and the day begins with ward rounds and then if you are attached to a surgical ward, there is always the option of going to see surgery. Otherwise there are outpatient clinics that you can sit in on and procedures like endoscopy or bronchoscopy that you can watch.
From day one of clinical school, students are taught basically medical skills such as taking blood, putting in cannulas and inserting catheters on plastic models. As long as the medical student is supervised they are allowed to do all manner of practical procedures. I have inserted chest drains, stitched up in surgery, and performed lumbar punctures (a procedure where you stick a really long needle into the spine to draw out fluid).
As students become more confident, the junior doctors often delegate them jobs to do such as writing out the discharge letters or taking blood. Medical students do provide the NHS with many hours of free labour, though I tended to leave small catastrophes in my wake whenever I tried to help.
When the exams draw near there is a mad scramble to practice examinations. There are set routines of how to examine a patient’s cardiovascular, nervous, respiratory and abdominal systems and the practical exams test your ability to perform the examination correctly and pick up all the signs.
Medical school is very hospital based. I expect John Watson’s tastes of General Practice would have been few and far between – a few weeks here and there. GP is very different to hospital medicine though it is also a nine to five day. As a medical student you are often given much more freedom – I ended up running my own clinics. The atmosphere of a GP surgery is also very different to a hospital. It is much more intimate and social. Instead of a clog in a machine, you feel more like a person and you really get to know the GPs, nurses and other staff very well in a short amount of time. The abundance of free tea, coffee and biscuits is also a big bonus.
I can see why John Watson decided to become a GP (Semantics of Healthcare 1) – it can be a very rewarding job and one of the few medical specialities that allows you to actually have a life.
Work Hard, Play Hard
So much for the actual work, what about the parties?
Medical students are renowned for their love of drinking, partying and general craziness. I still have a T-shirt that says “the Liver is Evil and must be Punished”. However in my personal experience medical school is damn hard work and you cannot coast through the course any more than you can expect to drift calmly down Victoria Falls.
Yes, there were wild times when the exams were done but by and large medical school is all about stamina. You have to keep working steadily throughout the year and studying independently because it is almost impossible to cram all the factual knowledge in the week before the exams. Studying can be very competitive and stressful. In my year about 5% of people either drop down a year or they simply left the course to study somewhere or something else.
I think medical school would have honed John’s focus and determination rather than made him an alcoholic.
There is time to do other things if you’re good at time management (or you just don’t care about exams). I imagine John probably played sports in his spare time and boozed through quite a few pubs and clubs in his time.
Medical school life can also bind people through bizarre shared experiences. Very few other students understand what we go through and are often confused, disgusted, and disturbed by “medic chat”. The last thing you want to hear whilst eating is the person sitting next to you graphically describing how they pulled 6 metres of intestine from a dead body and had a lot of trouble trying to stuff it all back in again.
The Joys of Being Qualified
If a student successfully passed their medical finals he or she becomes a fully qualified doctor. As the state has the monopoly on healthcare, nearly all medical students receive a job when they graduate from medical school. Currently, jobs are assigned in a vastly complicated computer system that causes endless grief.
In John’s day, he would have applied for jobs directly to the hospitals he wanted to work at. It was very popular for students to stay in the same hospitals in which they were trained. So if John went to Bart’s, he would probably have wanted to stay in Bart’s for work. However junior doctors’ jobs contain several different rotations through different specialities. It is unlikely that John would have stayed purely in Bart’s. In fact the CV made for TBB shows that John spent some time in King’s College Hospital.
I do think that John would have looked back on his medical school life as an overall positive experience. It was a character transforming time that would have made him into the man we recognize.
Side Note – I solemly swear
I’d like to take this opportunity to point out that doctors no longer take the Hippocratic Oath for several reasons. Firstly some of the notions it expresses are severely outdated. We cannot for example swear to “impart a knowledge of this art to my own sons, and to my teacher's sons”. Secondly, swearing oaths no longer has the same emotional/cultural connotations that it used to. Muttering a few words whilst holding a candle does not make you any better at being a doctor, nor does it suddenly provide you with moral scruples if you did not have any to begin with.
Only about half of medical schools in the UK make their pupils recite an oath upon graduation so not every doctor solemnly promises to “do no harm” on the eve of their qualification.
The Genius of Deduction
I personally believe that John’s time in medical school equipped him very well to be a private detective’s assistant.
I have written before that Sherlock’s particular brand of deduction is nothing magical, new or even extraordinary (The Truth about Deduction). It is the same method of deduction that doctors use all the time in their working life and one of the most important skills medical schools aims to teach.
Medical methods can often baffle outsiders as much as Sherlock does and even the most mediocre GP manages to look like a genius in the eyes of their patients once in a while. I think Sherlock’s deductive abilities are seen as extraordinary because we can compare him onscreen to the perpetually clueless police. The police are not universally trained in logical deduction to the same standard that Sherlock is.
Patients can’t usually compare doctors and nearly all doctors are trained to the same high standard anyway so getting it right is something that patients expect rather than admire. Hardly any of my patients ever express an interest in understand how the process of diagnosis works – in fact they probably wouldn’t care if I told them I psychically consorted with the spirits of healing to get the diagnosis. I think it is the almost supernatural ways that Sherlock’s abilities are portrayed that make people so attracted to his logical deduction even though it’s the same mundane process going on inside any doctor’s head.
Of course medicine is hardly simple, and we are all limited by the collective body of knowledge. Very few people actually understand what an inexact science diagnosing diseases is; all they see is the confident doctor telling them the answer at the end. In the same way I think we are all “duped” by Sherlock’s confidence and the fact that the endings always exonerate him. In fact, his brand of deduction is no more accurate than what doctors do at the bedside and John does frequently accuse Sherlock of guess – which the great detective partially admits to.
I want to point out that had John spent years of his life learning to look for the signs that Sherlock does, he would make just as a good a detective. This does not detract in any way from Sherlock’s brilliance as a character. He is still unique in that he is the only person to apply logical deduction of this calibre to crime solving.
Sherlock can walk onto a crime scene and tell you the answer in ten minutes but doctors too can walk into a cubicle and immediately tell what is wrong without the patient even opening their mouth – you just need to know what to look for, which signs are important and what associations to make. We don’t really care about whether your wedding ring is well polished on the inside because ethically we shouldn’t be deducing your private life. Although as a GP John would have learnt to “read” his patients very quickly. Doctors only have a very limited amount of time to sort out people’s problems. Out of sheer self preservation most doctors learn to deduce what patients want from the consultation quickly so they can actually go home on time. Also patients lie to their doctors all the time, particularly when on issues relating to child abuse, drugs and alcohol and these are not innocuous lies told by generally honest people. Genuine addicts are often seasoned deceivers and will try every trick possible to get what they want. John’s medical experience would have given him the skills to assess whether people are telling the truth.
If their roles were to be reversed and Sherlock had to fill in for John at the GP surgery he would be utterly clueless so I think that John Watson should be given due credit for being able to at least keep up with Sherlock on the topic of crime solving.
Both John and Sherlock have mirroring niche sets of specialist knowledge and skills, which to an outsider might look as if they are extraordinary but if you spent as much time learning medicine/deducing people as John and Sherlock have, you could be just as breathtaking and baffling to the general public.
If you want to know more about Sherlock's times at University - Oxbridge - Camford? Sherlock's University Life.