- Email: [email protected]
Junior hospital doctors—time to rethink the terminology
Correspondence
Junior hospital doctors— time to rethink the terminology The moment to abandon the terms junior and trainee, as applied to hospital doctors in the National Health Service (NHS), has surely come. The labels are discriminatory, belittling, untruthful in their application, and harmful to morale. Junior is misunderstood by the public and detrimental to confidence in the service, and trainee is demeaning and suggestive of incompetence and inferiority of status. We need appropriate terms to reflect the seniority and skills of this valued cadre of doctors. A doctor’s training is long and arduous. From the time of entering medical school, it takes a minimum of 12 years to reach consultant level, and often longer if factors like having children or pursuing research are added to the equation. Doctors in their 30s with high levels of experience and expertise are still labelled junior and trainee, yet these doctors are the backbone of the NHS medical provision—they staff services around the clock, and some are regularly the most senior staff member in a hospital at night. Receiving education is only a small part of the lives of these doctors, who are employed and paid by the NHS to work. Any junior will tell you that the training element of his or her working life is tiny compared with the weight of day-to-day clinical responsibility.1 Yet, 55 000 NHS doctors are caught in this net of pejorative nomenclature. In our survey of 514 staff, 55% of the 318 junior doctors responded that the terms were detrimental to their morale, and 59% that the terms had a negative effect on their clinical practice (appendix). By analogy, can you imagine policemen being termed junior until they become chief superintendents, or soldiers being called trainees until they become colonels? House officer, senior
house officer, registrar, and senior registrar are terms that were previously used successfully, carry meaning, make relevant distinctions, and could be reintroduced overnight. Patients are understandably misled by the terms junior and trainee. Their confidence can be undermined by the perception that they are being treated by someone who is less than fully competent. The issue is that training terminology is being used to describe doctors’ working lives. In our survey, only 18% of doctors thought that patients or the public understood the terms. We need to rethink our termin ology. Junior and trainee should be abandoned immediately, and more appropriate labels introduced—the cost of doing so would be negligible. Morale would rise and the effect would be transformational.
Published Online October 19, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)32707-1 See Online/Editorial http:// dx.doi.org/10.1016/S01406736(17)32708-3
I declare no competing interests.
David R Matthews [email protected] Harris Manchester College, Oxford OX1 3TD, UK 1
Clarke R. Your life in my hands—a junior doctor’s story. London: Metro Books, 2017.
www.thelancet.com Published online October 19, 2017 http://dx.doi.org/10.1016/S0140-6736(17)32707-1
See Online for appendix Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1
Junior hospital doctors— time to rethink the terminology The moment to abandon the terms junior and trainee, as applied to hospital doctors in the National Health Service (NHS), has surely come. The labels are discriminatory, belittling, untruthful in their application, and harmful to morale. Junior is misunderstood by the public and detrimental to confidence in the service, and trainee is demeaning and suggestive of incompetence and inferiority of status. We need appropriate terms to reflect the seniority and skills of this valued cadre of doctors. A doctor’s training is long and arduous. From the time of entering medical school, it takes a minimum of 12 years to reach consultant level, and often longer if factors like having children or pursuing research are added to the equation. Doctors in their 30s with high levels of experience and expertise are still labelled junior and trainee, yet these doctors are the backbone of the NHS medical provision—they staff services around the clock, and some are regularly the most senior staff member in a hospital at night. Receiving education is only a small part of the lives of these doctors, who are employed and paid by the NHS to work. Any junior will tell you that the training element of his or her working life is tiny compared with the weight of day-to-day clinical responsibility.1 Yet, 55 000 NHS doctors are caught in this net of pejorative nomenclature. In our survey of 514 staff, 55% of the 318 junior doctors responded that the terms were detrimental to their morale, and 59% that the terms had a negative effect on their clinical practice (appendix). By analogy, can you imagine policemen being termed junior until they become chief superintendents, or soldiers being called trainees until they become colonels? House officer, senior
house officer, registrar, and senior registrar are terms that were previously used successfully, carry meaning, make relevant distinctions, and could be reintroduced overnight. Patients are understandably misled by the terms junior and trainee. Their confidence can be undermined by the perception that they are being treated by someone who is less than fully competent. The issue is that training terminology is being used to describe doctors’ working lives. In our survey, only 18% of doctors thought that patients or the public understood the terms. We need to rethink our termin ology. Junior and trainee should be abandoned immediately, and more appropriate labels introduced—the cost of doing so would be negligible. Morale would rise and the effect would be transformational.
Published Online October 19, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)32707-1 See Online/Editorial http:// dx.doi.org/10.1016/S01406736(17)32708-3
I declare no competing interests.
David R Matthews [email protected] Harris Manchester College, Oxford OX1 3TD, UK 1
Clarke R. Your life in my hands—a junior doctor’s story. London: Metro Books, 2017.
www.thelancet.com Published online October 19, 2017 http://dx.doi.org/10.1016/S0140-6736(17)32707-1
See Online for appendix Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
1