What’s in a name, Junior?

What’s in a name, Junior?

by  Dr Dermot J Ward


“Junior doctor” problems have recently been painting the walls and carpeting the floors of the near total space of multimedia. Perhaps the most useful effect of the EU Referendum has been to totally change the theme tune of its mood music. At least that change is welcome…
Some years ago I was surprised to hear about a survey that discovered people were prepared to accept a drop in salary in exchange for what they considered to be a more important sounding title. Before that study if someone had told me this was a fact I’m pretty sure I would have greeted the idea with disbelief. And I would have been wrong. Specially for this piece I finally visited the website of ‘English Dictionary’, pioneer in dictionary publishing since 1819. (Not exactly the OED but suitable for my immediate purpose. It listed the meaning of ‘junior’ as an adjective as follows:- “1. Capital letter lower in rank or length of service; subordinate. Younger in years — ‘Junior’ citizen. Of or relating to use in childhood. (British) of or relating to school children between the ages of seven and 11.” Taken together, there are oodles of variations on the junior theme without major deviation conveying that adjectival flavour of youth and inexperience.
When I was newly qualified in Dublin and moved to 1960s London I was never a junior doctor; a houseman, yes, medical/ surgical, an SHO, Registrar, Senior Registrar (some doctors of that genre nudging 40). I can’t recall any use of ‘junior’ prefix then for doctor.

Returning to Dublin at the end of the ’60s, I noticed that doctor trainees were called and commonly referred to as NCHDs (non-consultant hospital doctors). I was struck at the time at its being perhaps a bit clumsy, but gave it little thought. That was Irish life. No big deal. I don’t know whose idea that was, but thank goodness they had it. Most readers will be aware there is acute turbulence at present in the NHS. Mind you, the most common and regular form tends to surround some variation on Mid-Staffs or similar scandal elsewhere. Apart from such dreadful outcomes there is also the industrial action of ‘junior’ doctors. The mass media has no problem filling newspaper columns and oceans of airwaves on this hot and vexed problem. My sympathies are with the trainee doctors, but the nitty-gritty of the disagreement with politician-driven working policy is not for today. I have little doubt that ‘junior’ doctors are a devil-send to the politicians.
I recall in my latter student days, the visible, and I mean visible to me, change that occurred in the demeanour and general personality of the young men and women who, less than a year earlier were still medical students, but now were Registered Medical Practitioners perhaps a month or two earlier empowered in law for the first time to responsibly undertake the diagnosis, treatment and care of patients answerable to the patient and perhaps relatives.

Also lurking and looking over their young shoulders was the GMC, as it was then. Yes, there were their senior colleagues hopefully backing them up, but even with that support the responsibilities are huge.Human and humane life are rightly regarded as the most precious form of civilised life in the animal kingdom. And woe betide the doctor who stands accused of carelessness or dangerousness in practice — and in these more litigious days we must add ‘inappropriate’ treatment and care as a possible ruination of a young (or older) medical life. Let us not forget that the NCHD is so often the first doctor to see, examine and initiate treatment of the most urgently unwell or injured patients in various aspects of emergency care, whether presenting within an inpatient hospital population or in an emergency department. Such is the burden of medical practitioners’ lives from day one registration.
Perhaps the BMA could ballot its total membership on this particular issue.

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