(art credit: Shewolf294)
Trishkafibble has done a wonderful job of piecing together John Watson’s CV from the episode: The Blind Banker. Many fans have been very confused by this CV and some inaccurate conclusions have been drawn from the information, still others have decided that this CV is completely rubbish and should be ignored.
- Why John’s CV is unorthodox but actually makes quite a lot of medical sense.
- What specific details like “clinical governance” mean and why John would mention them.
- What conclusions we can make about John’s medical and military career.
- How old John Watson is actually meant to be.
In part 2 – I will explore what we can learn about John’s background through his schooling and education. I also provide a hypothetical and better organised CV for John Watson.
"A conscientious reliable and hardworking medical professional, pays attention to details, crusader of clinical governance, with excellent interpersonal and time management skills, seeking further training and experience in accident and emergency medicine while working towards a career in laparoscopic and bloodless surgery."
Medical job interviews have, in the past, been rife with accusations of cronyism, nepotism and arbitrary decision-making. Today there is a strict checklist and scoring system for most medical jobs even at the lower end of the career ladder. GP surgeries are free to hire and fire as they please because they are in essence privately owned business enterprises. However they too need to appear “above board” with their job interviews, just in case a rejected candidate complains.
As a seasoned hand at advancing up the medical career ladder, I’m sure John Watson knew exactly which boxes to tick at the job interview and his CV would have been a good reflection of this.
At the very top of his CV John Watson has written his personal profile. This might look slightly odd to other professionals (and most doctors) but the whole point of this paragraph is to tick the “person specification” box.
If anyone would like to be bored to tears, they can go and read the bland multipage document issued by the General Medical Council which lists all the qualities that a good doctor should have. For every specific job there is a specific “person specification” listing the qualities, attributes etc a candidate should have. John’s personal profile is basically spelling out to the reader that he ticked the important boxes.
I rather like the fact that he’s put in “crusader of clinical governance”. Clinical governance is the technical term for making sure patients are well cared for and treated appropriately. In General Practice good clinical governance (as measured by yet another checklist) is rewarded with extra money from the government. Not all practices collect this extra money because it takes a great deal of managerial paper work to fulfil the criteria. What John is implying is that he is willing to put in the effort to make sure the GP surgery ticks all the boxes and thus brings in more money.
GP surgeries are very much money making enterprises just like a law firm, or a small company. They like to hire people who will be net contributors to the money pot and John is subtly saying that he has the drive and the experience to be a net contributor. He is in fact selling himself as a good investment.
More-Than-One Trick Pony
It is important to remember that in order to be able to work as GP locum, John has to be a fully qualified GP. However this does not mean he hasn’t been trained in any other medical/surgical speciality.
When John graduated from medical school, GP training was quite short. You can become a fully qualified GP five years after graduating from medical school. This leaves John plenty of time to pursue another career in surgery or accident & emergency or even both (Guide to making John a Realistic Army Surgeon). I have postulated before the he may even have had two careers - one as a doctor and one as a combat soldier (BAMF!John and Reality).
Today, as training programs for medical specialities become longer, switching between specialities is becoming harder. People are much more focused on becoming consultants (i.e. senior doctors) as quickly as possible. John might have chosen to forego the route of climbing one ladder very quickly – he might have decided to meander.
I personally think he found GP so incredibly boring that he packed it in and joined the army on a surgical training program, which might explain the rest of his personal profile.
“seeking further training in accident and emergency medicine while working towards a career in laparoscopic and bloodless surgery.”
The phrasing is very awkward and laparoscopic surgery is a technique used in many different surgical specialities so John doesn’t give any clues as to which speciality he is referring to.
This is not usual but it is acceptable given the job he’s applying to is one of locum GP. The GP practice isn’t expecting him to perform major laparoscopic surgery in their minor operations room. They don’t particularly care what his hopes, dreams, ambitions etc are, they want to know if he’s useful to them.
Instead what John is trying to demonstrate in one sentence is that he already has had experience in emergency medicine/surgery. This is appealing for a GP practice looking to hire because GP practices do get emergency patients on occasion, mostly, it’s meningitis and heart attacks. Therefore it is very important that all locum GPs are comfortable and experienced in dealing with common emergencies.
GPs also receive substantially more money from the government if they have doctors who can perform minor operations in their practice. Minor operations are not actually operations: they are usually putting in stitches or cutting out small skin lesions like moles, but if it saves the patient a trip to the hospital – it saves the NHS money. By saying that he is “seeking further training” (i.e. he has already had training), John is politely and humbly putting himself forward as the resident GP minor ops doctor. He doesn’t give too much information away and, though it isn’t a strategy I’d use to secure my job, the vagueness might intrigue the interviewer and allow John to tell them face to face what a useful minor ops doctor he can be.
Medical School/University Attended Qualification (s) Obtained From 2004-2006
King's College London Bachelor of Medicine; Bachelor of Surgery (MBBS) 28/08/01-21/06/2004
King's College London Intercalated BSc, Medical Sciences (Hons) 20/09/99 - 13/06/01
King Edward Grammar School Chelmsford 6 A* GCSE O/L 21/09/94 - 10/06/99"
John’s educational section is organised rather strangely. However, it still makes sense. I’m just going to talk about his medical degree in this part. His schooling and family background is fully explored in Part 2 and I also explain the discrepancies that some people no doubt have already noticed.
Kings College London does give its medical students the option of taking an intercalated year where they spend a year studying for a Bachelor of Science degree (as John has). However the intercalated year happens in the middle of the medical course and not at the beginning. In the UK you do not need a prior undergraduate degree to get into medical school – you only need A-levels. Also with an intercalated BsC the entire course takes 6 years and not 5 as the CV suggests.
It is entirely possible that John has given the officially correct dates rather than the literally correct dates. I too have a BA in medical sciences. Technically I only spent one year working for this degree but on my official transcript the University makes it look as if the first three years of my medical degree were spent studying for this BA. I have to now make my CV match the official transcript (even though it’s misleading). In the same way it is possible that John’s official transcript lists him has gaining his BsC in 2001 when really he did all the work at another time and he just has to go along with it.
To Bart’s or not To Bart’s
I do not know where the general assumption floating on the net about John having gone to Bart’s and the London Medical School comes from. It is certainly unfounded. Nothing in the episodes contradicts the information in the CV that John went to King’s Medical School.
When I actually re-watched ASiP the relevant quotes are:
Stamford to John: “Stamford, Mike Stamford – we were at Bart’s together.”
John: “Are you still at Bart’s then?”
Stamford: “Teaching now, bright young things like we used to be…”
Then in the lab: John: “Bit different from my day.”
Nowhere does John or Stamford actually say they were students at Bart’s and London School of Medicine. All that we know is that they were at “Bart’s”.
I think a lot of people don’t realise that this could mean a variety of different things. St. Bartholomew’s Hospital is a specific hospital but Barts Health (http://www.bartshealth.nhs.uk/our-hospitals/) is a large collection of hospitals including St. Bartholomew’s Hospital. When doctors working in the local deanery talk about the specific hospital they often call it St. Bart’s or Bart’s Hospital to distinguish it from Bart’s Health which is sometimes just called Barts.
Therefore when John and Stamford remise about their time together at Barts/Bart’s we don’t know whether they are talking just about the hospital or the whole group of hospitals in the trust.
It is much more likely to be the latter meaning: i.e. the Barts group of hospitals.
Stamford says that he is still working at Barts, which implies that for as long as John has known him – he’s been at Barts. Some medical students do stay to work for the rest of their careers in the same group of hospitals but hardly anyone manages to just work in one particular hospital for their entire career, simply because of how the doctor’s job rotations work. Even in the first two years 90% of junior doctors end up at least two different hospitals within a group. We can see a typical example in John Watson’s CV.
There is no evidence that John and Stamford went to Bart’s and the London Medical school. It is merely a convenient but unfounded assumption. When John walks into the pathology lab, and it is mostly like the pathology research lab because Molly, the pathologist has free access to it, he is merely commenting on the change from “my day”. He never specifies it was his days as a medical student at Bart’s Hospital. He may be generally commenting on the progress of lab technology or the fact that the use of the room has changed from perhaps a ward to a lab.
Furthermore, medical students do not usually spend any time in pathology research labs, unless they are taking time out to do a specific research project and they chose to do pathology project. The conventional medical degree does not have space or time for students to gallivant off for pet projects – you spend most of your time either memorising lecture notes or shadowing doctors. For clinical experience, most of the time you have to be there because you have a sign off sheet that records your attendance – if it’s not completely filled you do not get to take your final exams. The fanfiction idealised scenario where you can unofficially find a willing scientist to let you in to spend nights doing your own little side projects secretly in the lab is illegal due to health and safety reasons.
Many students choose to move out of the deanery where they studied just to get to work in some new hospitals. There are many hospital groups in London to choose from – for example: John changed from South Thames deanery where King’s College is based to North Central where University College Hospital is based.
Even when Stamford obliquely mentions their student days all he says is that they were “bright young things,” this quality is not unique to Bart’s students!
It is much more plausible that John and Stamford spent time working in same hospital within Barts Health together after their junior doctor years. John then joined the army and Stamford stayed on and got himself a position in the Barts and the London Medical School.
The General Medical Council keeps a mandatory, legal register of all qualified doctors in the UK. It also acts as the judge, jury and executioner for doctors who misbehave. It can and does hold disciplinary hearings and reserves the right to disqualify doctors for life.
The GMC number is unique to each doctor, and it can be used by employers to check that the applicant is not a fraud. It is generally good practice to put your GMC number in your application form (in fact most places demand it outright). This proves that you are a qualified doctor, the reason the actual number on John’s CV is not possible to read is in case the producers hit upon a real registration number.
Membership of a Defence Union
The NHS provides all doctors with medical indemnity insurance as part of their work contract. In fact in the UK it is almost impossible to sue a doctor (i.e. a civil case). All civil litigation cases are brought against the NHS trust or hospital where the grievance took place. Individual doctors are named in the case and may be asked to give evidence but they are not held personally liable. In theory this should mean that it’s very hard to successfully sue for a medical grievance because the NHS has a dedicated legal division and an army of lawyers.
However to save on legal costs, the NHS usually settles out of court. This does not sit well with many doctors who feel that they are not being well represented by the NHS lawyers. In many cases of medical negligence, the plaintiff (patient) usually has very shaky legal grounds and would lose if the NHS continued the fight. Doctors thus feel that they are being besmirched in the evidence dock and justice is not being served.
This is where organisations like the Medical Defense Union or Medical Protection Society come in. They will act in the best interests of their members and continue the legal battle on their behalf. They also offer loads of great free legal advice and provide indemnity cover for doctors doing private work.
It is not a legal requirement to join the MDU or MPS but nearly every doctor is. Their fees are very reasonable – nothing like the huge sums that US doctors have to pay. Membership starts from £10/year for a junior doctor and they give you a free book.
Name and Address: Employer Grade and Speciality From 2004 - to 2006
University College Hospital London PRHO General Surgery and Medicine(Under Professor Barber and Dr Cullens)
Broomfield Hospital Chelmsford SHA Trauma and Orthopaedics (Under Mr Taylor) 04/02/05 - 02/04/05"
Many people get very confused by John’s employment history. In the actual episode John’s CV spans several pages so there’s no reason to believe that he only had two jobs. It looks to me as if he listed the jobs he did in chronological order and his employment history actually spans onto the next page. The skills and proficiencies part interrupts this section (very unorthodox but possible because John wanted it to be on the front page for easy reading).
Alternatively he specifically put his civilian jobs on the front page as the rest of his employment history is with the army (probably in Afghanistan) and therefore of less relevance to the civilian setting. The two jobs that John listed have to be civilian jobs because junior doctors who join the army train at specific army affiliated hospitals such as Peterborough. Neither Bloomfield nor UCH are affiliated hospitals.
I have to say that from the two jobs I can see, the producers actually got most of their facts correct.
The jobs on the first page are junior doctor jobs. As a junior doctor for the first two years, you rotate around many different specialities to get a flavour of both medicine and surgery. PRHO position is John’s first year as a qualified doctor which would have been from August 2004 - July 2005, and then SHO is his second year which would have been from August 2005 - August 2006.
The dates specified for his SHO job are not correct - each junior doctor rotation lasts for either 4 or 6 months. Usually it is either 6 rotations of 4 months jobs or 3 rotations of 4 months and then 2 rotations of 6 months.
It is the norm for doctors in London Deaneries (geographical areas of related hospitals) to do one year in a central London Hospital and then another year outside London. Therefore John working in UCH, which in the center of London and then Chelmsford which is outside London is typical of a junior doctor rotation.
However, what they did not get right is that Chelmsford belongs to the North East Thames Deanery – run by Barts and the London Medical School, whereas University College Hospital belongs to the North Central Thames Deanery run by University College London medical school. It is possible that John swapped Deaneries during his junior doctor’s years, some people do.
There is no evidence that John trained at Bart’s Hospital on the front page. However he might have gone on to do his more senior jobs at Bart’s. Additionally he might have visited Bart’s during his time at Chelmsford for courses run by the North East Thames Deanery as Bart’s is one of the Deanery’s major teaching hospitals.
The last possibility is that in John’s day Deanery boundaries were different – I can only use my knowledge as a present day junior doctor to comment. It might be that the job rotation of UCH meant he spent some time in Bart’s due to an affiliation. I have one rotation where I need to travel between two different hospitals but I am only officially employed by one.
Just because he’s done a year in Trauma and Orthopaedics does not mean John is actually an orthopaedic surgeon. You need to train for six to eight years in that particularly speciality to qualify as an orthopaedic surgeon. In reality John’s job would have been looking after patients on the ward after surgery and being a general paper-monkey.
For more information on what John would be doing as a junior doctor: read this post.
I assume that over the page – John lists his GP training jobs and then his jobs as a GP (whether it was in the army or the civilian world). I have said this many times before: John has to have finished his GP training in order to be a locum GP. As we don’t see that part of his employment history on the front page, it’s quite obvious that the employment history is incomplete.
An Estimate of Age
We can see that John did a 5 year course at King’s College London. As the vast majority of medical school pupils enter at age 18 after finishing secondary school, and is the same for John as his CV states that he went into medical school as soon as he finished his secondary education in 1999, John would have been 23/24 when he graduated medical school in 2004. Therefore in 2010 at the beginning of season one – he would be 30 years old at the most. He would only have deployed to Afghanistan after finishing medical school – he cannot complete his medical school training abroad. Therefore the longest period of time John would have officially been serving in the army would be 6 years from 2004 – 2010.Martin Freeman is clearly older than 30 in ASiP but John Watson being only 30 fits very well with his Captain's rank at discharge. Doctors in the army have ranks in accordance with their pay and this means their rank increases very quickly (though the ranks do not mean they command soldiers, they are purely administrative). Captain is the starter rank for junior doctors who join the army. A mid rank doctor would be a Major and a Consultant would be Colonel or higher.
In the Army Now
(art credit: IncenteFalconer)
As we can see, John spent at least up until 2006 training in the UK. At the end of his second job: John has to reapply for new jobs all over again. This would have been the natural break in his career where he would have decided to join the army.
I want to point out that joining the army as a doctor is not something that many medical students/doctors aspire to. Though it is competitive, being an army doctor is a niche ambition and people join up for many different reasons, most of which have nothing to do with money. Civilian doctors are paid just as much as military doctors, though they do not get the accommodation benefits, but given the size of the pay cheques, living expenses really aren’t a burden.
I personally think that John is an adrenaline junkie and found being a civilian junior doctor far too boring. He wanted to travel the world and experience all it had to offer, whilst still working up the medical career ladder. Alternatively, there might have been a dearth of civilian jobs at the particular time. There have been many occasions in the last few years where doctors have been forced into a bottle neck on the career ladder due mostly to government policy changes. The army always has room for an extra doctor, though you might not get to choose what you specialise in. I believe GP was not John’s first choice of job (given his professed love of surgery); it was just the program with the most vacancies waiting to be filled.
Skills and Proficiencies
The skills and proficiencies listed are things which all medical students have to demonstrate before they get to qualify as doctors. These are standard skills that every doctor is assumed to have. I can recognise and treat myocardial infarction (heart attack)/severe asthma (and even life-threatening asthma with the help of ITU). Writing a list out like John has done is very unorthodox, however there is a semblance of sense to the madness.
These emergencies are more likely to present themselves in hospital but they do occur in GP practices as well. Unfortunately GPs are not always proficient at coping with emergencies just because they don’t see these situations all the time. John is pointing out that he is comfortable dealing with such emergencies and if anything like this should come through the door – he would be comfortable handling the situation. He is evidently trying to set himself up as the “emergencies guy”.
He may also be hoping to get work on the out-of-hour emergency GP service. Most areas in the country are covered by an emergency GP service run by a consortium of GP practices. This service pays locum doctors very good rates because they have to work anti-social hours. It is definitely a great way to make money quickly for any GP. The things on the skills list are the most common cases that GPs get called to on their out-of-hours rounds. Therefore making it very plain to the GPs that he likes emergencies – is going to get John’s foot in the door.
Several people have pointed out that should John want to show off his proficiency in emergencies he would have mentioned his Advance Trauma and Life Support qualification (which all doctors in the army have to do). Though ATLS sounds impressive, it’s actually rather useless in a GP setting because GPs just don’t stock the equipment you need to successful do ATLS. I’m sure he mentioned it on the next page, somewhere, but the whole first page was dedicated to showing why he would make a good GP.