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As a medical student and soon to be doctor, I often watch TV programs about medicine and despair. Not because the likes of Casualty and Holby City (for those of you who don’t watch British TV these are hospital dramas) are not entertaining, but rather because they have a habit of misleading the public on what real doctors can do.

So in the spirit of annoying people with useless information –  I have produced a small guide to writing fanfiction involving John Watson’s career as a doctor so that you can Brit-pick and Medical-pick your own works if you want authenticity.

Dr Watson, MD MBBS, MRCGP



Getting into the Army


Amendment:The most common way to join the army would be qualifying as a civilian doctor and then under taking the Professionally Qualified officer training course. I discuss this primarily in Part 2.

However many people who eventually go on to serve in the army as doctors do so through a sponsorship program called the Medical Cadetship. You apply to the army at the same time as applying to medical school. Should you successfully gain a place at a medical school, you enter a contract with the army. They will sponsor you through all 5 or 6 years of medical school, with very general living expenses grants, and pay all the tuition fees. In return you have to serve in the army for a minimum of 7 years after graduation and the army dictates which branch of medicine you specialise in.

A note to American friends across the pond – medical school fees in the UK are no more expensive than any other university course. Given John’s age – when he went to medical school it was free. Thus John has never been burdened with tuition debt.

It is however interesting to think why John would volunteer to join the army. We can see that he is a bit of an adrenaline addict but civilian medicine provides a healthy dose of adrenaline in most specialities. You don’t need to be sent to the sweltering hell that is Afghanistan to get a fulfilling adrenaline rush if you have a medical degree. Thus I propose that John might not have come from a long line of doctors as many people have portrayed. Perhaps he really did need the money in order to cover the cost of living in London because he comes from a lower middle class/working class background and thus a medical cadetship would be ideal. Although many medical students have doctors in their family, most students come from a diverse range of family backgrounds.

(Side note to American friends – John has an MB not an MD. The exact letters awarded to him after graduation depend upon the medical school. In the case of Barts and the London School of Medicine it is MBBS. Although we don’t know his exact age, I assume he is over 35 years old. Thus when he started training as a doctor at age 18, he would have first trained at either St Bartholomew’s Hospital Medical College or London Hospital Medical College. The two then merged as Barts and the London in 1995. In order to get an MD in the UK you have to do two extra years of postgraduate research/study, which John may not have had a chance to do given that he’s been in Afghanistan.)

In the Army Now






(British Army Medical Officer Uniform - for anyone who wants to draw John in Afghanistan accurately)

All doctors in the Army are commissioned officers, so John being a Captain is not a sign that he has shown proficiency on the battlefield or even proficiency in the realm of medicine. As you progress through your medical training you get automatically promoted to the next military rank in the same way that you would get promoted from a Senior House Officer (SHO) to a Specialist Registrar in the civilian word.

For those of you who are utterly confused by the “ranks” of doctors in the NHS, don’t worry even the doctors are confused but this is generally how one progresses through the ranks:

1.       Two years of foundation training directly after graduation (equivalent to Interns in the US) called FY1 and FY2. When John graduated these training jobs would have been called House Jobs and he would have been called the House Officer*.

2.       Spend a year or two as a Senior House Office whilst you try to get a speciality training post.

3.       Get on a speciality training program e.g. GP, dermatology, renal medicine, orthopaedic surgery. You are now a Specialist Registrar

4.       Slog through 5 to 9 years of speciality training and become a Consultant. Everyone below Consultant level is called a junior doctor because they have restrictions on what they can do and must be supervised to some extent by their Consultant.

(*Side note - I've just realised that when John graduated about 12 - 14 years ago there wasn't a foundation program! In his first two years as a junior doctor he would have been called a House Officer and then he would have progressed in the same route as today)

In the army, when you graduate you are commissioned as (I believe) a Second Lieutenant and advance through the ranks accordingly. Therefore John as a Captain may be the equivalent of a Specialist Registrar. So he’s not a senior officer and he’s not a senior doctor either – he’s still in training.

Fighting in Afghanistan


John did not fight in Afghanistan - he was not a combatant.

Medical Officers in the army do not leave the base unless there are extraordinary circumstances. All their work is done in within the hospital/clinic at the base. The fan works that have John on patrol and fighting the enemy are incorrect. The medics who accompany patrols, carry weapons and patch up soldiers on field are not doctors they are paramedics (Medical Support Officers). They do not have a medical degree and are not referred to as Doctor.

Doctors in the army are all given weapons training so it’s not far fetched that John can shoot well but it’s not an essential skill set for an army doctor because 99% of the time you don’t see any action.

The only way I can think that John Watson could have been shot is if his base got overran with insurgents or he flew out to pick up a wounded soldier and then got caught in the ensuing gun battle.

Although there is another way for John to be totally BAMF on the battlefield, as you can read in part 2 of Semantics in Healthcare.



GP Land





All doctors must specialise in one area of medicine (General Practice is a specialism). You can no longer do general surgery or general medicine.

For those of you wondering what John specialised in – you can be sure it wasn’t trauma orthopaedics.

John was a GP* in the Army.

(*Side note - GPs are the equivalent of family doctors in the US. They see and treat minor illnesses and refer people who have major problems to specialists at the hospital.)

Why? Because he came back to London got a job was a GP. You cannot switch from one specialism to another without starting all over again in your specialist training. We know that John didn’t start his GP training from scratch because he started working in the surgery as soon as he was hired. GP trainees start off on hospital rotations before being based in a GP surgery.

He would have got a job as a locum doctor, meaning that he only came in to the surgery to fill in for doctors on leave. This is why he has so much time to run after Sherlock. He’s not a salaried GP and he’s not a partner at the GP practice. However the pay for locums is very good so he will have no problems with the bills.

In order to get a locum job John would have to be at least a Specialist Registrar in GP training. GP practices do not employ Senior house officers or anyone more junior as locums. John would have got his locum job not through a private agency* like other temporary workers but through contact with the Primary Care Trust (PCT). PCTs control the healthcare budget for all the healthcare services in a given area. GPs are held accountable to the PCT (who give them their money) when they fail to provide an adequate health service (e.g. someone's on maternity leave). In return they ask the PCT for locums who would be available to cover. So John didn't just walk off the street into Sarah's clinic, he had a prearranged interview through the PCT for that job.

*Amendment: addyke has informed me that there are agencies that help PCTs recruit locum doctors. These agencies can sometimes be Europe-wide. In John's case he could only legally work in English speaking countries i.e. UK and Ireland. John does mention that he went to Dublin during a week in ASiB, perhaps he was doing a locum job there? As the General Medical Council of the UK routinely share information with the Medical Council of Ireland, it's plausible that John could get a locum position in Dublin over a weekend. Scotland, Wales and Northern Ireland are chronically short staffed.


As a locum he would have great control over the hours he worked because he is in effect self-employed. He doesn't get an NHS pension or the same job security as normal doctors. However there is usually more demand for locum hours than locums want to provide, so John is not in danger of a shortage of work any time soon. Therefore John doesn't have to fret about loosing his job at the surgery - he can always find another and it would end soon anyway, most locums only work in one place for a few days to weeks. The only loss to him from leaving would be that he doesn't have a good reason to see Sarah everyday anymore.




Part 2 - How can an Army GP be fighting on the front lines? John's Dual Career



Feedback

All comments, thoughts, criticisms welcome. Perhaps you know more about this than me so feel free to correct!

Comments

( 66 comments — Leave a comment )
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ex_swaggerd
Aug. 29th, 2012 09:54 pm (UTC)
I always wondered why he had nightmares of combat and how he was shot if he was a doctor. I like your theory about him going in to retrieve a wounded soldier and getting caught up in the combat. Actually... I think I have a new plot bunny. Thank you! This will be an invaluable resource for my writing and understanding John's character. Thank you so much for taking the time to write this up!

Edited at 2012-08-29 09:55 pm (UTC)
wellingtongoose
Aug. 30th, 2012 02:54 pm (UTC)
Thank you so much! I'm glad it gave you some food for thought. If you want to write BAMF!John on the battlefield you can have a look at my theory in part 2 http://wellingtongoose.livejournal.com/7885.html.

I think it fits everything rather better than John the army GP.
sophiap
Aug. 29th, 2012 10:31 pm (UTC)
This is excellent stuff - I've pulled together some info like this during my own research, but you've presented it far better than I could have.

Anyhow, while I am a huge fan of combatant!John, and am writing him as such, having this information lets me know what I need to do as a writer to make that believable.

In short, based on what a normal Army doctor would be like, what led to a military career where John would identify more as a soldier than a doctor (per ASiB) and state that he has killed people? There's lots of rooms for interesting stories there.
darth_stitch
Aug. 30th, 2012 01:42 am (UTC)
One of these days, we Soldier!John fangirls need to get together and give him a CV that makes more sense lol. XD
(no subject) - keerawa - Aug. 30th, 2012 02:16 am (UTC) - Expand
(no subject) - ariadnechan - Aug. 30th, 2012 03:38 am (UTC) - Expand
(no subject) - wellingtongoose - Aug. 30th, 2012 02:02 pm (UTC) - Expand
(no subject) - wellingtongoose - Aug. 30th, 2012 02:57 pm (UTC) - Expand
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lizardspots
Aug. 29th, 2012 10:51 pm (UTC)
Yes! Thank you! I've always thought someone needed to provide some accurate info about John's medical career, and though I was inspired to try, I never got round to it. Plus I know sod all about army medicine. This is great, thanks for putting in the effort - I learned something new.

Lizard (F2 doc) :D
wellingtongoose
Aug. 30th, 2012 02:03 pm (UTC)
Thank you very much - I hope that it was accurate enough. I just realised today that when John graduated from med school there wasn't a Foundation Program at all. He would have been a House Officer and then Senior House Officer.

Anyway hope F2 is treating you well, I heard it's stressful.
agentotter
Aug. 29th, 2012 11:08 pm (UTC)
This is outstanding, thank you! I had always thought it was possible for him to have done something like this fellow who posted an AMA on reddit:
IAmA former Army field doctor with 4 tours under my belt AMA

There's a ton of really interesting info and first-hand accounts in that thread, mostly from Americans I think, if anybody's interested. From reading the thread it seems this particular doctor is an American, but it sounds like his job basically consisted of flying out on the helicopter to do medical evacuations of wounded.

With John it's also possible that he was wounded while in transit to somewhere else, performing a medical evacuation from a base to an airstrip or a more equipped hospital location, something like that. (There's a user in in that linked thread above called Mustaka who describes a scenario where he's transporting doctors, though I'm not sure when he says "army doctors" whether he's referring to actual doctors or medics.)

Anyway, would that sort of job be completely out of the realm of possibility for somebody who specialized in GP? Is there a field (like trauma surgery) in the UK armed forces that would be deploying its doctors in the field?

This is all just really interesting... I think in John's case they just screwed canon by making it too contradictory. I can't think of a way to really reconcile it without dismissing either what we see of his flashback in "A Study in Pink" or handwaving him getting the GP job in the next episode. Or maybe John doesn't have nightmares about the war, he has nightmares about documentary films he's watched about the war. He's a sensitive soul. ;D
wellingtongoose
Sep. 1st, 2012 12:17 pm (UTC)
Thank you for this very insightful comment. I believe that if John was an army GP in training, he would on a rare occasion be sent out to retrieve a wounded soldier. The soldier wouldn't be terribly wounded, mind you, that would be a call to the trauma specialists. Alternatively on on particular mission the RAMC were short staffed and drafted John in to help.

I've written both Part 2 (which explains how John can be both a doctor and fight in combat) and Part 3 (how to make surgeon!John realistic). Hope they will be helpful, you can view them on my profile page.
(Deleted comment)
wellingtongoose
Aug. 30th, 2012 02:59 pm (UTC)
Thank you for your support. I do love John is BAMF and shoots with deadly accuracy so I went and wrote another theory for how a doctor can fight on the frontlines.

http://wellingtongoose.livejournal.com/7885.html

Do tell me if you think's realistic.
cleflink
Aug. 30th, 2012 12:05 am (UTC)
Very interesting! Am I right in thinking that a GP is not a surgeon? Because that would make for an interesting deviation from the original ACD!Watson.

Thank you for sharing! ^_^
wellingtongoose
Aug. 30th, 2012 02:05 pm (UTC)
A GP is not a surgeon (they are the Family Doctors of the UK). Canon ACD Watson was an army surgeon but at that time doctors did not specialise. You could do both medicine and surgery (any type of surgery). Therefore ACD!Watson wouldn't have had to choose a narrow field in which to work, he could have done everything that was medically helpful to the army.
(no subject) - cleflink - Aug. 30th, 2012 02:22 pm (UTC) - Expand
love_bug_54
Aug. 30th, 2012 12:36 am (UTC)
Thanks for this! My own experience is in the US Navy decades ago and then doctors were not line officers and did not see combat, unless, like you said, they somehow found themselves attacked on the base or while travelling between bases. Doctors are too valuable to risk on the front lines, so medics are the ones more likely to be in harm's way during a battle.

But, this John Watson is an MD because his Victorian counterpart was an MD. John Watson, MBBS, etc., doesn't have quite the same panache (not to insult those who've earned those titles). We also know that Watson was wounded when his unit was overrun by "the murderous Gahzis." We see something similar during the opening scenes of Study in Pink, which was Moffat/Gatiss' way of introducing the character as he was introduced in the Sherlock Holmes Canon.
wellingtongoose
Aug. 30th, 2012 03:01 pm (UTC)
In ACD John is an MD because that was what all doctors got when they graduated but just as the telegram has been updated to a mobile phone, I think we should update John's letters to MBBS.

I like the idea of John fighting on the frontlines so I wrote part 2 of this series about how John the doctor could be a fighting soldier

http://wellingtongoose.livejournal.com/7885.html

I;d love to hear your thoughts and thanks for the comment!
(no subject) - tweedisgood - Sep. 2nd, 2012 08:27 am (UTC) - Expand
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(no subject) - tweedisgood - Sep. 2nd, 2012 08:54 am (UTC) - Expand
blue_midnight
Aug. 30th, 2012 02:29 am (UTC)
Very interesting stuff! It's always nice to read different theories on back stories.
wellingtongoose
Sep. 1st, 2012 12:06 pm (UTC)
Thank you so much! Part 2 and part 3 are now up as well.
ariadnechan
Aug. 30th, 2012 03:00 am (UTC)
I know about this but i think our writers were trying to John more as Watson from the books

So i think John it was not in the program, perse, and that's why he doesn't fit

I believe he finished maybe step 3 to be GP and then he enter the military at the academy and so he was a captain, captain who works as a med in his unit, not in the program, because if not the first scene and all the watson background have no sens at all specially what John himself says in the series.

In the books there were doctors who went as meds with units like Watson, and ones who stay at bases... So there was no problem with that.

But now for us to hace our Watson i think he have double status militar and medical carreres and that's why the dreams, the injury and his background.

Edited at 2012-08-30 03:50 am (UTC)
wellingtongoose
Aug. 30th, 2012 03:04 pm (UTC)
Yes I agree with the double military status and I worked out how it would happen in real life.

It's pretty anti-canon but might prove interesting

http://wellingtongoose.livejournal.com/7885.html

Please tell me what you think.
azriona
Aug. 30th, 2012 03:11 am (UTC)
Some of the research I did into the Cadetship program indicated that when John graduated from med school, he'd automatically become a Captain. (Granted, the information stems mostly from Wikipedia, so I'm willing to believe it's not entirely accurate.) I don't remember anything about Second Lieutenants - though I have to admit, since we know that John was a Captain at the time of his discharge, and given his age, he's probably been in the army since he left med school, it doesn't make sense for him to still be a captain ten or fifteen years later.

(Not so much a correction, because clearly you know more than I do; mostly I'm curious for your comment re: John's rank?)
wellingtongoose
Aug. 30th, 2012 02:06 pm (UTC)
I wrote part 2 of this semantics in healthcare series and I've come to conclusion the only way John is a Captain at his age is if he's actually a career soldier not a career army doctor.

If you'd like to read it http://wellingtongoose.livejournal.com/7885.html and tell me what you think?
swissmarg
Aug. 30th, 2012 05:16 am (UTC)
I don't know anything about how the army works, but I'd just like to throw out abundantlyqueer's meta Dr John Watson, or, The strange case of the Army doctor's worn-out boots, which suggests that he was actually a medic because that covers his apparent combat PTSD and the dream/flashback at the beginning of the first series.
wellingtongoose
Sep. 1st, 2012 12:13 pm (UTC)
Oh yes - I've read this essay and it's very good but I have to say some facts in it are inaccurate.

I would like to point out, that the vast majority of doctors in the RAMC (which is the corps the all doctors in the army belong to) join the army through the Medical Cadetship like AMEDD and not as fully qualified doctors. You can join as fully qualified doctor but even then you do not get to choose how much of a combat role they have. They don't have a combat role at all.

An army medic can be anyone with a first aid kit strapped to their back. The actual medics who go on patrol are the medical support officers (equivalent of paramedics) and combat medical technicians (who are not commissioned officers). Neither of these roles are performed by people with a medical degree. Therefore if John was a medical support office he wouldn't have the title of Doctor.


(no subject) - swissmarg - Sep. 1st, 2012 12:22 pm (UTC) - Expand
trishkafibble
Aug. 30th, 2012 06:05 am (UTC)
Thanks for this valuable resource!!

You got me so intrigued that I went off and pored over the CV screencaps, and ended up writing a transcription of it to post on my LJ page. ^^ What I find most fascinating is that John's CV doesn't mention his military service at ALL. Wouldn't that be an asset on a resumé??

What he does mention is an Intercalated BSc in Medical Sciences (with honors) from King's College London, and an MBBS from King's College that's listed "Bachelor of Medicine; Bachelor of Surgery." His employment history shows a PRHO at University College Hospital London and an SHO at Broomfield Hospital Chelmsford, which is listed as "Trauma and Orthopaedics" (and unless either John or I got the dates wrong, that job only lasted two months. Perhaps because his enlistment intervened?).

That's the full extent of his CV info, apart from some (rather suspect) dates, his registration with the GMC and the MDU, and a list of skills that certainly doesn't include surgery!

I'm an utter layman on the subject, but between your explanations and Wikipedia's, I'm at a loss to divine exactly what Sarah was referencing when she said that John was overqualified for the locum job. As you say, he seems by all rights to be still a doctor in training, with nothing visible to distinguish either his academic or post-academic career. Looks to me like the CV was written more as a plausible prop to be waved about in the scene than a canon document, which certainly may be the case.

I'd love to hear your comments on any of this information. How does it mesh (or not) with your expectations, and with the canon itself?
wellingtongoose
Aug. 30th, 2012 03:03 pm (UTC)
Thank you for pursuing the screen shots of John's CV. I completely agree with you on the reading though it was a bit hard to decipher from a few seconds of shots.

I've tried to give some answers to all your questions in part 2

http://wellingtongoose.livejournal.com/7885.html

Hopefully you would find my theories a bit more in line (or much more out of line) with canon.
(no subject) - addyke - Aug. 30th, 2012 08:30 pm (UTC) - Expand
(no subject) - wellingtongoose - Aug. 30th, 2012 08:48 pm (UTC) - Expand
(no subject) - addyke - Aug. 30th, 2012 09:24 pm (UTC) - Expand
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poetic_self
Aug. 30th, 2012 07:55 am (UTC)
That was very enlightening! Thank you!
wellingtongoose
Sep. 1st, 2012 12:02 pm (UTC)
I'm glad you liked it there's a Part 2 and a Part 3 on my LJ as well, if you're interested.
ruric
Aug. 30th, 2012 08:13 am (UTC)
I don't write in Sherlock fandom but guides liket his are fab - thanks for taking the time to write it. *bookmarks for future use*
wellingtongoose
Sep. 1st, 2012 12:02 pm (UTC)
Thank you very much.
mildred_bobbin
Aug. 30th, 2012 08:20 am (UTC)
interesting! thank you! lol my head canon is that it was like the British equivalent of MASH - Hawkeye was a Captain too, so they were close to battle, but not in battle unless a (not so) hilarious misadventure occurred.
wellingtongoose
Sep. 1st, 2012 12:01 pm (UTC)
Thank you - I prefer the theory of retrieving the wounded soldier, although in ACD canon John is injured after his base gets overrun by insurgents.
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