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I've had many wonderful discussions with readers in the past few days! Thank you all very much. 

Many people have expressed a desire to make John an Army Surgeon. I understand why John the army surgeon is such an appealing idea and adds wonderful depth to his back story. 

Part 3 is a short guide to how John the Army Surgeon can be made compatible with reality. It's just an interesting meta on what John went through to become an army surgeon and what he would actually do on the frontlines. I also explore why he's Dr Watson and not Mr Watson, where John actually got his medical degree from, and how John can have an MD in the modern age of medicine. 




Like a Surgeon...


ACD!Watson vs BBCSherlock!John: a brief history of British Medicine

In ACD's canon John Watson is an army surgeon. It’s hard to reconcile this with the GP version of John we have in the modern adaptation. However at in the nineteenth every doctor in the army had surgical training and could be considered a surgeon.

An army surgeon at that time was a multipurpose professional. Remember this is over a hundred years ago when doctors did not specialise in a particular field of medicine. You could do both medicine and surgery (any and all types of surgery). In the modern era this is simply not possible. Orthopaedic surgeons only operate on bones; plastic surgeons only patch up skin and soft tissue. Thus one wounded soldier would need many different doctors to attend him in the present day, whereas in ACD's time one doctor would do everything for the patient including his follow up care. 

In order to update John Watson - we have had to give him a speciality and the only speciality he can possible have if he managed to get a locum GP job in London is General Practice. This is still in keeping with his ACD canon counterpart as a GP has the broadest workload of any doctor. He would be able to treat anything from a broken finger to malaria. John would never have performed major surgery but GPs in the army can do small surgical procedures that don’t involve general anaesthetics such as stitching up wounds and removing sutures. 


Guide to making a John a Realistic Army Surgeon

I have had many comments from people who really want John to be an army surgeon because that’s what ACD!Watson did and it also opens up some awesome potential in terms of fanfiction. Who am I to deny people their ArmySurgeon!John? So here is a handy (not-too-serious) guide to making John the Surgeon as realistic as possible:

John’s GP Training – When John graduated from medical school GP training was much more loosely organised and less formal. It may be that he spent 2 to 3 years after finishing his hospital House Officer Jobs working as trainee GP. During the time John was practicing it was much easier to change from one speciality to another so he could have changed his mind and decided to become a surgeon instead after qualifying as a GP. 

(My headcanon – John started training as a civilian GP trainee and then decided he wanted to do surgery instead. However surgery training posts are always hard to get in NHS hospitals so John might have joined the army surgery training program instead, which is still competitive but the army always needs more surgeons. Doctors can join the army in this way but you miss out on army sponsorship during your medical school. On the other hand, you do not have to sign a minimum contract to work for the army for 7 years.)

John’s Surgical Specialty - The army has a restricted range of surgical specialities – demand is very high for trauma specialists. In civilian NHS hospitals the orthopaedic surgeons operate on nearly all of the trauma cases with the help of the plastic surgeons who repair skin and soft tissue. However they mostly deal with road traffic accidents and violent crime. Gunshot wounds are very rare in UK hospitals because possession of guns is still quite rare even amongst the criminal classes. Most violent crime involving weapons are committed with knives.

However in the army the major causes of trauma are gunshot wounds, shrapnel and explosions. Therefore the army requires a large number of trauma specialists. If you want John to be a surgeon – the most likely surgical speciality he would be a  specialist "trauma surgeon" (not an orthopaedic surgeon). Trauma specialists aim to stabilize soldiers who have sustained massive trauma as that they can be moved out of the country to receive more specialist intensive care treatment and follow up in the UK. 

There are other types of surgeons in the army and they are deployed to the front lines but they would not be responsible for operating on the soldiers who are heavily wounded. They are the second line of treatment once the trauma specialists have done their job. It is also the trauma specialists who fly out to pick up wound soldiers on the battlefield.

I have said in Part 1 that retrieving wounded soldiers may be how John was routinely sent into full combat. He would on these missions be given full body armour and stand issue weapons to defend himself. He would in some cases have had to fire back at the enemy but that would not have been his priority.

(Side Note - The army does actually employ civilian doctors in large military hospitals away from the frontline in Afghanistan. I assume that these doctors are better trained to provide the long term care that wounded soldiers need.)

Thus most of the doctors that ever enter the combat zone would be trauma specialists and we all know John would want to be as near to the fighting as possible.

John’s surgical training – Trauma specialists cannot be easily trained in military hospitals in the UK. They really need to be in regions with active combat in order to learn the skills they need. Therefore it is likely as soon as John gained a place on the trauma training program he would have been sent out to whatever active war zone was available.

Although the war in Afghanistan only started in 2001 and Iraq in 2002, the British Army has been deployed as part of NATO and UN peacekeeping forces to some of the most war torn areas of the globe. Therefore John really has seen “enough [trouble] for a lifetime”. He probably was only a few years out of medical school before he was introduced to the adrenaline inducing, horrific world of real battlefield medicine.

 All surgical training programs are split into Core training and Speciality training. In Core training you learn general surgical techniques that can be applied to nearly all operations. In speciality training you learn to do all the operations that your speciality routinely performs: for orthopaedic surgeons it would be joint replacements, for eye surgeons it would cataract surgery. However trauma specialists do not perform elective surgery (i.e. all their operations are emergencies) and they have to deal with a wide range of problems. Therefore their specialist training would be much like a continuation of Core training as they need to acquire a very flexible set of surgical skills. 


Addition: Surgical training officially takes between 5 to 9 years but because Consultant posts are highly competitive and require a great deal of experience, in reality it takes 8 - 15 years of training to become a Consultant. Some of these years would be used to get extra qualifications such as an MD or a PhD (yes John would then be Dr. Dr. Watson) and doing fellowships abroad in different parts of the world. John probably never took time out to do a fellowship abroad as the Afghan war broke out early in his training. 

In the field of trauma, experience is very important because of the emergency nature of their work and the many different types of cases they must contend with. Therefore senior doctors need many years of experience behind them in order to be competent enough to make good clinical decisions. I believe that when John got invalided out of the army he would be getting to the tail end of his training but he wouldn't be a Consultant surgeon yet. 

      

(For those who want to draw John's military uniform correctly!)

John the Army Captain – In Part 1 (Exploring Dr Watson's Army Career) and Part 2 (BAMF!John and Reality), I have pointed out that after 10 – 15 years of graduating from the medical school, John should have advanced further up the career ladder than Captain. As an army doctor you are automatically promoted to next military rank when you advance up the medical career ladder. Your promotion has nothing to do with your efficacy or experience as a military officer.

John still being a Captain can simply be a sign that he is still undergoing his trauma specialist training when he was invalided out of the army. Promotions in rank are given in accordance to time spent in the Army and pay. Captain is a relatively junior rank for a qualified doctor in the RAMC. 


Side Note: Enlistment - John did not enlist in the army because the rank of Captain is a commissioned officer. If you enlist in the army you can only be promoted to non-commissioned officer ranks, the highest of which is Staff Sergeant. A commissioned officer was traditionally any officer with a "royal commission" i.e. a directive from the Queen. Commissioned officers are not promoted along the same system as enlisted soldiers and their commission was used to distinguish them from the ordinary non-commissioned officers. 

In the modern day all commissioned officers in the army must go through a course at Royal Military Academy Sandhurst. Professionally trained officer candidates like John would go through a shorter course as he does not actually need to lead troops into battle. However he does need to acquire some leadership skills because he is going to be a commissioned officer. 


John’s actual job - As a surgical trainee John would get to do a lot of the straight forward operations on his own. He would definitely be able to extract bullets and sow up gunshot wounds without supervision as long as the bullets haven’t nicked something vital. He would probably not be doing amputations – this is the job of the orthopaedic surgeons. Instead he would be working with anaesthetists who have training in intensive care to physically stabilize wounded soldiers i.e. stop internal bleeding, extract shrapnel, sow up wounds, bandage wounds as best as possible. However in complex patients John would be the assistant surgeon to the Consultant during the operation. He would also not be in the position to make final decisions on treatment and he must defer to his superiors.

John, as a more junior member of the surgical team, would participate in retrieval missions more than the Consultant surgeons. This is because Consultants are very valuable and trainees less so. It makes more sense to send junior doctors into the combat zone because they are more expenable. Thus John would probably be pretty handy with a weapon if he has to routinely fly into combat areas, much more so than any of his bosses. 

The Mystery of Mr Watson - It has been pointed out to me that John can’t be a surgeon because he would be referred to as Mr Watson and not Dr Watson. This is both true and not true (confusing right?). A surgeon only gains the right be referred to as Mr/Mrs/Miss once they pass the all important Membership of the Royal College of Surgeons (MRCS) exam, which aspiring surgeon taken towards the end of their core training program. This exam needs to be completed before you advance to a specialist training program. Unlike in GP, all trainee surgeons do Core training and then Specialist training, which is why it takes much longer to train as a surgeon than as a physician.

If your heart tells you John is definitely a surgeon not a GP: John could still be Dr Watson if he started a Core surgical training program but never finished it before being invalided out of the army.

Alternatively he may just like being called Doctor and he legally has the right to carry that title. It’s more a point of pride amongst surgeons that they drop their doctor title and not a legal requirement. Unless they have spent time under the surgeon’s knife, other people who meet John may not know the age old tradition of referring to a surgeon as "Mister". It gets quite difficult for surgeons, particularly in their private lives, to explain to people why they don’t carry the title of doctor. It usually confuses people and makes them question whether you are “a real doctor”.

Also if John spent most of his time working at the Camp Bastion Field Hospital, which is the major military hospital in Afghanistan, he would have worked closely with American colleagues. American surgeons definitely go by the title of Doctor and perhaps John got into the habit of referring to himself as Dr Watson. 

(Side note – for anyone who is interested, the reason why surgeons are referred to as Mr/Mrs/Miss is because in the eighteenth century all surgeons were “barber surgeons”. They had no formal training and where not considered part of the medical profession. The Royal College of Physicians snootily refused them the title of Doctor. However once surgery really took off in the nineteenth century the surgeons decided they rather like being distinguished from their physician colleagues and started the practice of dropping the Dr. title from their  name once they became members of the Royal College of Surgeons)

This does raise the very interesting question of just what does Miss Molly Hooper do – because she’s not a pathologist. If you’re confused by this I’ve written a nice little meta about her as well.


John's Orthopaedics Job - several people have pointed out that John’s CV (on screen caps during TBB) shows that he trained in trauma and orthopaedics. I think it says: PRHO at University College Hospital London, SHO at Broomfield Hospital Chelmsford, which is listed as "Trauma and Orthopaedics".

I understand this was drawn up by producers who probably know nothing about medicine but I have to say in this case they actually got it right. 

This is a typicaltypical junior doctor rotation. PRHO is his House Officer job, the first job he got straight out of medical school and SHO is his second year job. As a junior doctor you rotate through many different hospitals and specialities, moving every few months. This does not mean John specialised in orthopaedics – if he did he would have spend 7-9 years doing it instead of a few months as it says on his CV.

He might have been interested in orthopaedics but it is more likely that this was just the rotation he ended being allocated to by the hospital or Medical Deanery (the body responsible for the medical education of junior doctors within each group of hospitals). In this rotation he would have done only civilian trauma not battlefield trauma.

*Pictures in this section courtesy of the army.mod.uk. These images are actually of real army doctors in the RAMC, a good reference point for anyone wanting to draw John in uniform.

Give John back his MD!

John’s MD – Amendment: Doctor of Medicine is a higher qualification that requires a two year original research project, similar to that of a PhD. MD are more popular with surgical trainees, whereas medical trainees tend to favour PhDs. I believe this is because PhDs take 3-4 years of full time research. This is a long time to take out from surgical training and your surgical skills inevitably become rusty if you are not practising full time. This is often less of a problem in medicine there are less practical procedures that require muscle memory. 

Higher research qualifications give specialist trainees essential research experience. Consultants, especially medical Consultants, in teaching hospitals are usually required to participate in medical research as part of their contract. Therefore having an MD or a PhD would give any specialist trainee a good foundation for their Consultant post and it is a something that most employers will look for. 


However in order to do most research projects you need access to a well equipped laboratory. If John Watson was an army surgical trainee on the front line he would not have the facilities to do an MD. If John Watson is a GP trainee, he would have no need for an MD because there would be no expectation for him to conduct medical research once he has finished his training. 

If anyone would like John to have an MD because it makes him sound awesome, there are some realistic ways you can do this:

  1. If your headcanon says John is a surgeon then at some point in his training he would have got an MD. I think John would have probably investigated the best way to extract bullets from deep tissue (this is actually the title of someone’s PhD thesis) or new techniques for wound closure. These projects could potentially be acceptable and not need access to a research laboratory. 

  1. If you believe that John has to be GP in order for it to fit canon – John may still have an MD, though most GPs don’t go in for that sort of thing. Their top jobs are not as competitive. However a research project might have caught his eye – it would be more along the lines of biochemistry/pharmacology he’s a medical doctor not a surgeon. There might be a plot bunny in there when Sherlock stumbles upon John’s ago old dissertation and realises just how clever John really is.

John’s Medical Degree

(Kings College London)

King’s College not Barts – I have been informed by the eagle eyed trishkafibble that John’s CV says he got his MBBS from King’s College London but in the show it Sherlock says he trained at Barts!

Most likely the producers made a mistake. However I love to look for in-universe explanations for the unexplainable so here we go:

John did spend time in St. Barts Hospital but as part of his House Officer Jobs after he graduated. We can only see two jobs listed on the CV at University College Hospital and Broomfield; in reality you have at least 6 different jobs in the first two years of being a doctor. Each job would be in a different speciality and possibly in a different hospital. So it’s plausible that John worked at Bart’s with Stamford during his junior doctor days. Barts Hospital is very busy and requires a huge number of junior doctors to staff; it is also highly regarded as a teaching hospital for trainee doctors (and medical students).

Today St. Barts Hospital is used predominantly for Barts and the London medical school to train their medical students. However a small number of Kings College and University College London students end up in Barts Hospital for one or two placements. It’s all rather bizarrely organised. Don’t worry if you’re confused, the medical students are even more confused.

In ACD canon John got his medical degree from the University of London not Kings College. This squares well with his modern counterpart because John technically did get his degree from the University of London whether he went to Barts or King's College. All universities in London up until very recently issued their graduands with certificates from the University of London. It does fit quite nicely with canon, no? 





Part 1 - Exploring Dr Watson's Army Career

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



Feedback is very welcome - I love to discuss things with readers!

Comments

( 41 comments — Leave a comment )
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ariadnechan
Aug. 31st, 2012 10:42 pm (UTC)
I really like this idea of john Doctor gp, joining the army to train as a trauma surgeon!
Then he could work after as a gp? Without problems?

Because in this case we can understand better why Sarah think he is is over qualified for the post in her clinic no?

And he can patch Sherlock better also. And i thought too that was a good way for him to be invalidated as a army dcotor, because he can use an scarpel with a bad hand.

How much time the training as a trauma surgeon last?

John can take his Md after comeback from the war? Or he need to return to the Uni more formally for that? (like redoing some courses or something?)



Your metas are awesome!

But about the second one i really loved the first draft better!
My headcannon is made on a stone he was civilian doctor and then he enter the academy after that he went to war.

But this one is awesome too!
wellingtongoose
Aug. 31st, 2012 10:53 pm (UTC)
As long as he did start his GP training and he's still registered with the GMC he can legally work as GP locum. As locums are in great demand they really aren't fussed about how many years experience their GP locums have. As long as you passed the membership exams for the Royal college of GPs they will take you. I guess this is part of the reason why Sarah thought John was over qualified. Their normal locums are probably fresh faced and wet behind the ears.

If John was a surgeon he would be invalided out possibly due to his hand tremor but as Mycroft says: the tremor disappears under stress and surgery is stressful. I assume that the army believed that there would loss of mobility in his shoulder which would imped on his surgical ability.

Additionally as John is a valuable asset to the army but his contract with them has expired. They can't legally hold him any more. I think his honourable discharge was as much to do with John wanting to leave the army, as the army thinking John wasn't fit to stay on.

I'm actually going to update this meta now because of the great questions you raised - I hope it will answer all of your questions.
(no subject) - ariadnechan - Aug. 31st, 2012 11:15 pm (UTC) - Expand
(no subject) - wellingtongoose - Aug. 31st, 2012 11:29 pm (UTC) - Expand
(no subject) - ariadnechan - Aug. 31st, 2012 11:37 pm (UTC) - Expand
(no subject) - wellingtongoose - Sep. 1st, 2012 11:46 am (UTC) - Expand
(no subject) - ariadnechan - Sep. 1st, 2012 06:24 pm (UTC) - Expand
mymuseandi
Aug. 31st, 2012 11:13 pm (UTC)
Hi! All three parts of your Semantics of Healthcare is very very interesting.. and I love that you give suggestions as to the different John Watsons a writer could write for if he/she has no idea how Healthcare works in the UK. There are a lot of possibilities to explore!

Just curious, because sometimes I get so into semantics and then not getting it just right and decided to shred every piece of reality out there and just go with my imagination because I'm just that frustrated: Do you still enjoy those kind of fics, speaking from someone who is well-versed on what's going on in the 'doctor-ing' world (see, making up words already!)?

Is there a link to the meta that you wrote for Molly Hooper? I would love to read it.
wellingtongoose
Aug. 31st, 2012 11:31 pm (UTC)
Thank you for all your support!

Molly Hooper's meta is actually part 4 of Semantics of Healthcare. I'm going to read it through a few times before posting it - the other parts have too many typos!
rachelindeed
Sep. 1st, 2012 12:35 am (UTC)
I have really enjoyed reading all the options you've laid out for writers so they can wind their way more realistically to their preferred version of John's BAMF-ery :) Kudos! Thanks very much for sharing all this.

One question on the topic of why John was invalided out -- I really know nothing about either the medical or military professions, but is there any convincing modern equivalent for Watson's experience in "A Study in Scarlet"? There, he says that he was hit by a jezail bullet which shattered the bone. Again, I know almost nothing, but I have heard that at the time of the original Doctor Watson's war experience in Afghanistan, jezail rifles were sometimes loaded with nails, pebbles, etc., and that bullets made from melted bits of shrapnel were more likely to break apart inside a person's body and thus act more like explosive rounds. This makes me wonder whether it's possible that there might be pieces of a bullet still lodged in Watson's shoulder/chest that were unsafe to remove or increased his risk of infection? Could that possibly affect the potential risk to his health and professional performance even after basic recovery and mobility were regained?

The second thing Watson says in "A Study in Scarlet" is that he was recovering decently well from the bullet wound when he got enteric fever (aka typhoid?) at the base hospital in Peshawar and wound up bed-ridden and near-death for months. After it became clear that he would survive, he was so emaciated and weak that the medical board on site sent him straight back to England, believing he would never recover a normal level of health. Now, I suspect that with modern medicine it would not take months for a person to recover from typhoid, but could John have perhaps contracted another difficult-to-treat, antibiotic-resistant infection after he was wounded that debilitated him for a long time and pushed him so far out of basic fitness that it could explain why he and the army parted ways at that point? I get the sense in "A Study in Scarlet" that Watson himself believed he would never recover enough to trust himself in the field again, and if John had a similar self-evaluation I could see him deciding to just walk away from the army if he were no longer under contract and felt that a long and painful attempt at full rehabilitation would be ultimately fruitless. It's never clearly established how long John has been back in London since he was discharged, or whether he spent any recuperation time somewhere else before London. In short, maybe his health could have been a lot worse to begin with, and the point at which we are introduced to him in "A Study in Pink" represented the apex of a long recovery and the most he ever expected to achieve?

This is total, pure speculation, but I thought I'd throw it out there.
wellingtongoose
Sep. 1st, 2012 11:33 am (UTC)
Thank! This has been very enlightening. I read A Study in Scarlet when I was a kid and haven't gone back to look at it since. Your theory has got me writing an another part this series (oh dear this is never going to end...)

I'm going to try and explore John's injuries - how they'd affect his life, and how they can compare with ACD!Watson. It might answer some of your questions.

Thank you for all amazing input and inspiration!
(no subject) - rachelindeed - Sep. 1st, 2012 10:31 pm (UTC) - Expand
bugeyedmonster
Sep. 1st, 2012 05:06 am (UTC)
Thanks for doing all this. I rather enjoyed reading this. Though I might have to do another re-reading to 'fully digest' it all.

wellingtongoose
Sep. 1st, 2012 11:34 am (UTC)
Thank you for the support! I realise it's full of typos but as long as the message is easy to understand and vaguely interesting, I'm happy
pennypaperbrain
Sep. 1st, 2012 12:11 pm (UTC)
Thanks a lot for not one but three such detailed metas. Duly bookmarked for reference in my future writing.

I have a tangential question which I’m hoping you might be able to take a minute to answer. I’m currently writing a series in which, amongst all the other problems of chasing down Moriarty’s network while officially dead, Sherlock’s latent bipolar has kicked off. John is trying to work out what the hell is up with his friend, and I’m wondering how (un)informed John would be, given that his speciality isn’t psych but on the other hand he’s experienced PTSD and must have dealt with traumatised soldiers.

Diagnosing bipolar is considered difficult and I’ve even met psychiatrists who seem bewilderingly unclued on the subject... but what resources would a doctor with John’s background have in his head, and if he wanted to try to get help or a second opinion, while on the run in a foreign country with an officially dead ‘patient’ who’s actually his friend and doesn’t much want to co-operate, what would he do?
wellingtongoose
Sep. 1st, 2012 12:25 pm (UTC)
Wow, Sherlock Holmes with bipolar - that's a great issue to sink my teeth into, thank you.

Diagnosing bipolar in its early stages is very difficult because it can manifest itself as singular depression or depression and even worse depression or just a manic episode with depression. In people with bipolar there is not really such thing as latency. They get episodes that are spaced out in time (usually between months to years) so most people suffer from bipolar disorder for years before being accurately diagnosed.

Now you need to decide how long Sherlock's suffered bipolar for. Usually it starts in late teens early adulthood. The higher the number of episode you have had the more typical your next presentation will be i.e. you will have both a depressive episode and a manic episode. Thus at maybe 35 Sherlock might have had bipolar for 10 - 15 years, on and off so his symptoms by now should be quite classic.

John would have done the obligatory 2/3 months in psychiatry during his medical school years and then he would have seen psychiatric patients in his junior doctors jobs before he got shipped off to Afghanistan. Also bipolar disorder might crop up when he's working as an army GP as most mental health on the front lines is dealt with by the GPs. So I think John would be quite clued up on what bipolar is and at least be able to recognised the classical signs.

Acute manic episodes are usually treated with lithium or anti-psychotics (the stuff they give to people with hallucinations). Depending on which country they are in, John might be able to buy lithium over the counter at a pharmacist and maybe spike Sherlock's food? Otherwise a bipolar episode isn't a psychiatric emergency. It tends to burn itself out after some time. If the patient refuses treatment we usually section them under the mental health act - doubt John can do that on the run so he's just going to have to buckle down and ride the episodes out.

Usually its the manic episodes that worry people- Sherlock would be disinhibited, impulsive, excessively happy/giddy, unable to make logical decisions, and potentially endangering their lives. I guess John would probably tie Sherlock to a bed until he got better or swung into a depressive state.

Edited at 2012-09-01 12:31 pm (UTC)
(no subject) - pennypaperbrain - Sep. 1st, 2012 12:49 pm (UTC) - Expand
(no subject) - wellingtongoose - Sep. 1st, 2012 05:47 pm (UTC) - Expand
(no subject) - pennypaperbrain - Sep. 1st, 2012 06:01 pm (UTC) - Expand
spiderine
Sep. 1st, 2012 02:05 pm (UTC)
As well as an ACD Holmes and BBC Sherlock fan, I'm also an avid reader of Patrick O'Brian's Aubrey-Maturin series. When I read the Doyle stories, I thought of Watson being a "surgeon" the same way that Maturin is a "surgeon" -- not so much a profession as a posting.

All doctors in the Royal Navy at the start of the 19th century (Napoleonic Wars) were "naval surgeons". This is because, yes, a lot of the so-called surgeons in His Majesty's Navy had been culled from the ranks of butchers, animal doctors, barbers -- any man who could pull a bullet, dose a fever or cut off a leg. In fact, Maturin was a very rare bird indeed as an actual physician serving on a ship of war (a grand point of pride among the Surprises). Maturin was ultimately offered the post of Physician of the Fleet, which I presume was the equivalent of Admiral rank to oversee the practice of naval surgery, but he refused it so he could continue to sail with Aubrey.

I thought it was the same for Watson in the Royal Army during the Afghanistan campaign -- that a physician in civilian life could be called an army surgeon because that was the name of the posting.

Am I incorrect?
wellingtongoose
Sep. 1st, 2012 05:32 pm (UTC)
Yes you are! ACD!Watson didn't start off his medical career in the army simply because at that time the army didn't have any facilities to train real doctors. ACD!Watson would have joined after becoming a fully qualified doctor with some years of experience behind him. Remember in the Victorian era all healthcare was privatised and there wasn't a rigid training system like we have today. Instead you pretty much tried to apprentice yourself to the most famous doctors or to a famous hospital. I personally think that ACD!Watson would have worked for a few years as a general doctor in one of the big London hospitals (i.e. he could do both medicine and surgery) to make enough money to pay off his student debts.

I think ACD!Watson joined the army out of a need for excitement but also because at that time, towards the end of the Victorian era, Britain started to build the beginnings of a modern army and the army recognised the need for real doctors. Pay and conditions in the military were still no match to what you could earn as a civilian physician but they were improving.

As you said for Maturin - he could move from a relatively minor career in civilian medicine to a very high position within the navy. To a lesser extent I think this is what attracted ACD!Watson.
cleflink
Sep. 1st, 2012 02:52 pm (UTC)
John certainly isn't making it easy to find a logical explanation for why he's such a BAMF, is he? ^_^

Another fascinating bit of meta! You've clearly put a lot of effort into finding a reasonable explanation for all of this and to giving everyone a chance to decide what interpretation they prefer. I now kind of want to see someone talk about John's dissertation about bullets and deep muscle tissue. *grins* Thanks also for including that explanation about the Mr./Miss/Mrs. issue for surgeons - fascinating!

Also, I watched that documentary on Sandhurst that you recommended last time and found it very interesting - thank you for the link!
wellingtongoose
Sep. 1st, 2012 05:25 pm (UTC)
I'm very happy that you found this useful. I wasn't sure that anyone would actually find these little facts about medicine even vaguely interesting so I'm overwhelmed by the responses I've received.

I'm writing part 4 of this (oh dear when will it end?) and it's going to be mostly about John's shoulder wound and PTSD. Do you think it would be interesting?
(no subject) - cleflink - Sep. 2nd, 2012 05:27 pm (UTC) - Expand
trishkafibble
Sep. 2nd, 2012 04:14 am (UTC)
Wow, great job once again!! I'm glad you found my CV useful (if anyone's interested, it's here), and I'm also glad that you've found several inventive but plausible ways to fit that very annoying document into a workable backstory for John. The Sherlock Powers That Be sure do make us work for it!!
wellingtongoose
Sep. 2nd, 2012 03:40 pm (UTC)
Brilliant! I need to delve a bit deeper into the CV thing - probably in part 4. There are some issues that can be straightened out or rather bent to fit reality!
(no subject) - trishkafibble - Sep. 2nd, 2012 05:14 pm (UTC) - Expand
(Anonymous)
Sep. 2nd, 2012 09:25 pm (UTC)
Thanks for the meta
This was a great series of meta you wrote. I hope many writers discovers it and uses it. So many stories seem very unrealistic to me when it comes to John's doctoring. I think one of the problems is that with all the US medical shows we get on TV that alot of fan-fic writers base there medical knowledge on these, not realising the UK system is totaly different.

I was wondering if you could add an appendix to your explanation though. In a nearly all the fiction I have read on the net they have made John totally ignorant on all forms of science except biology (and sometimes not even that). I've studied medical science myself and there was an absolutely huge amount i had to know from physics, bio-chemistry, neuro-physiology, pharmacology, maths, etc. I should imagin it's even more intense for a medical degree. I was hoping you might explain some of the course work you had to do to get your degree?

Thanks
Looking forward to your thoughts on Molly, I've often wondered what her roll was exactly in Barts:-)
wellingtongoose
Sep. 2nd, 2012 09:36 pm (UTC)
Re: Thanks for the meta
Thank you very much! I will add an amendment to bottom of this article about John's medical education.

Molly is going to have to wait for a bit. I'm still writing about John's psychosomatic limp and his PTSD :)
(Anonymous)
Sep. 3rd, 2012 08:48 am (UTC)
I'm surprised that you estimate many/most MO's come in through the cadetship programme - I don't think the number of cadetships has ever been more than 30 in a year, and it usually hovers around 20, but the non-cadet intake each year is over a hundred. Is it a feature of where you are that there's a disproportionate number of very smart young doctors? (If so, damn your luck.)
wellingtongoose
Sep. 3rd, 2012 12:08 pm (UTC)
I might have a very very skewed idea about how people join the army as doctors because the military hospital where I am placed at the moment is basically filled with Cambridge medical students and staffed by doctors who came through the medical cadetship.

Do you have a source for the number of medical cadetships issued each year. I was under the (possibly wrong) impression that there was more than 20. I though the number would be somewhere more around 50 odd?
(no subject) - (Anonymous) - Sep. 3rd, 2012 07:57 pm (UTC) - Expand
(no subject) - wellingtongoose - Sep. 3rd, 2012 08:50 pm (UTC) - Expand
(Anonymous)
Sep. 3rd, 2012 11:04 pm (UTC)
This is a great post, thanks so much! *mumble mumble have to rewrite story now*

I have a question though. In this post, one thing is unclear to me: if John had "joined the army surgery training program" would he be RAMC? Or would he be the medical officer of XYZ company (Fifth Northumberland)? (Or both, hell, I have no idea how these things work.)

Thanks so much for doing all this!
wellingtongoose
Sep. 3rd, 2012 11:09 pm (UTC)
He would be in RAMC. All doctors belong to the RAMC and they work together in military bases, have their own mess and generally hang out with other doctors.
ammorgan21
Sep. 8th, 2012 09:46 pm (UTC)
I love it,as I spent my whole life hearing about how my parents went through the US system. They started off as medics, but my mum became a nurse later thorough the money the army gave for education(not an NCO though) and my dad was an paramedic later, but also trained as a helicopter medic/paramedic and there was something about infantry training (I assumed it was just because my dad's just one of those type of people who has to try everything) and this was right after Vietnam. They weren't doctors, but they did have an idea how they joined. They were later in the National Guard (which is the Territorial Army from what I know of living in Britain) and were able to study and be a soldier and all that good stuff. I assume the Brits aren't too far off from the Yanks. I thought the way they wrote Watson was just too inconsistent yet you helped it along in a canon way. Besides wasn't ACD a doctor in training, that's where he got the inspiration for Sherlock?

I am mostly commenting because you have helped me organize so much better than what my life time of stories has told me.
livejournal
Sep. 9th, 2012 12:01 am (UTC)
Saturday, 8 September 2012
User thisprettywren referenced to your post from Saturday, 8 September 2012 saying: [...] at (Various) Facts: Semantics of Healthcare Part 3 - Guide to Making John a Real Army Surgeon [...]
girlkamikazi
Sep. 9th, 2012 03:54 pm (UTC)
Another fantastic meta! Thanks for writing this bit up.

I'm definitely interested to see what you have to say about Molly. (Can I also add that I'm really interested to see if anyone writes out your plot bunny? I think a fic where Sherlock stumbles upon John's dissertation would be really good read.)
etoiledunord
Sep. 10th, 2012 07:28 am (UTC)
Thanks so much for posting these metas! I've just gone through and read them all, and they're really informative and useful. I do have one thing I'd like a bit of clarification/further input on, though, if I may ask.

Your headcanon theory from an earlier post mentioned that you suspected John may have found a GP specialization to be boring, so he decided to join the army. I'm not sure if you meant he would be an army GP, a fully trained officer who happened to have a medical degree, or that he would respecialize as a surgeon. Personally, I find the last option interesting, so I wonder if this would be a viable option. If so, would he be required to put in seven years with the army like those who receive sponsorship for medical school? Or would he simply become a junior doctor again as a regular army employee with the truncated Sandhurst training? I like this idea because it potentially explains his lower rank, allows him to choose to leave the army after getting shot, and resolves the GP/surgeon debate. I assume, though, that it would be unlikely that he would have had time to complete his surgery specialization before getting shot if he already put in the 3-5 years to become a Consultant GP, which would also settle the Dr/Mr debate. Though, if there was time (magic time warp!), he could also have been doing the bullet extraction MD you mentioned. That would be... a lot of specialization. o.O
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