wellingtongoose (wellingtongoose) wrote,

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The Semantics of Healthcare - John wasn't fighting in Afghanistan he was busy being a GP!

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.


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


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

Tags: meta: john watson

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