The unwritten rules of stethoscope placement....and what you wear when.

Learned that because doctors and medstudents don't wear uniform in UK, you can identify one from t'other by stethoscope position. Who knew?!
— AnneMarie Cunningham (@amcunningham) October 8, 2014

I'm quite fascinated by the culture around what different health professionals wear in hospital, and also what different health professionals wear around campus. In the UK, medical students do not wear uniforms on placements; they wear their own clothes. They no longer wear white coats. When I was a medical student I am sure we were identifiable on wards by our ill-fitting white coats, before anyone saw our university name badges.

Cardiff University medical students are given lanyards to hold their university IDs, and I heard recently that there may be an unwritten rule that this lanyard should not be worn around campus... or people might just think you were showing off.

Of course doctors in the UK don't wear white coats now either, so fitting vs not fitting white coats are not a way to quickly visually distinguish doctors from medical students. Instead, I learnt today that the position of your stethoscope is now an unwritten rule about your seniority in the medical profession. Some (doctors and students) think that only doctors should wear stethoscopes around their necks. Some have even suggested that the unwritten rule might be that you shouldn't wear a stethoscope around your neck until you are a little bit further up the ranks... maybe having passed professional exams! Even more curious, there is a rumour that this unofficial way of distinguishing medical students from doctors may be sabotaged by infection control guidance preventing ANYONE from wearing a stethoscope round their neck.

It's also worth noting that from a patient's perspective just knowing someone is a doctor is not enough.

@amcunningham Stethoscope meant DR, but emergency med, or general med, or cardiology, or haematology? When parked/oncology ward? Confusing.
— Tricia Murphy-Black (@Pogster) October 8, 2014

We need to remember to always say #hellomynameis and explain who we are and why we are talking to the patient on this occasion.

So I was wondering... should it be easier to identify medical students? Should doctors and medical students wear uniforms too? How do patients visually distinguish medical students from doctors, as I'm sure they are pretty unlikely to know these rules, and does it matter? And has the significance of stethoscopes to doctors in the UK gone up as they've stopped wearing white coats?

Edit : Some doctors in the UK do wear uniform! @sally_bobs is a respiratory consultant in Chesterfield. All doctors and medical students in @royalhospital wear navy scrubs which indicate if they are consultants.

@amcunningham pic.twitter.com/z6yu8PlmM5
— HellomynameisSally (@sally_bobs) October 8, 2014

And ENT consultant, John McGarva, @IamChirurgicus, even designed his own which highlights his specialty.

@amcunningham @sally_bobs I unilaterally invented my own when moved to new build. Saves hassle but am yet to see copy pic.twitter.com/0qFpmJ8jk5
— John McGarva (@IamChirurgicus) October 8, 2014

More about the importance of the lanyard... some have colour coding to distinguish role. In this particular case they were brought in to help distinguish staff at the time of a cardiac arrest. But interestingly lanyards are seen as an infection control risk in some trusts as well.

.@e_hothersall @amcunningham So do we (& colour coded): dark blue for cons, light blue ST3+, yellow CT1-2, green Fs pic.twitter.com/8TOFTDgSG1
— Philip Pearson (@respirologist) October 8, 2014

Why I realised the importance of the psychosocial in medicine...

Women of the world by robynejay

Students often don't seem to understand why the social sciences are important to understanding health and the way that we organise health services. The relevance has always seemed rather obvious to me but then I have to wonder if this doesn't have something to do with my own personal circumstances. Or else wouldn't all medical students think the same? So a few facts about me, the person who entered medical school in Belfast aged 18:

• I grew up on a small farm in Northern Ireland
• I'm the eldest of 4 children
• My maternal grandmother died in childbirth
• My mother's aunt started living with us when I was 6. My mother cared for her for 25 years until she died aged 103
• My family had a great interest in politics and my father was elected as a local councillor
• My father died suddenly when I was 14
• The family income fell as a result of my father's death but we were no longer entitled to free school meals
• I took a GCSE in sociology when at school. My coursework project considered why although the school was predominantly female, we only made up 1/3 of the a-level physics class.

I don't usually write about personal things here and there is a lot more I could say about what might have shaped my identity as a doctor. I am left wondering if many students don't question the structures and practice of medicine (insights that can be gained from the social sciences) because nothing in their own personal lives has sensitised them to the way that we organise society. 

If this is so, what can we do about it? If I am wrong, then what can we do about it? Either way we need to do something to shake things up.

Metaphors of Medicine... and implications for medical education

Just a short post. Last week I saw Annemarie Mol speak at COMET09 about the 'messiness' of clinical practice. Today I received an email from a colleague where we were discussiing the fact that many aspects of medicine do not "offer a script". And then through Rakesh Biswas I came across this blog of Shashikiran Umakanth, a physician and associate professor in India. His former student comments that "no patient comes in a neatly packed diagnostic disease".

So these metaphors of medicine are about its complexity and unpredictability. But do we acknowlege this in our medical courses?

What are your metaphors for medicine and how do they inform the way we prepare students to become doctors?