Hospital Hierarchy -- still present

Before I go on with the Starr book, I wanted to comment on an article I just found. "In a Hospital Hierarchy, Speaking is Hard to Do." This is a NY Times article published in April 2007 that summarizes how hard it is for medical students and new physicians to speak up in front of their older colleagues. The author, Barron Lerner, traces this hierarchy back to the medical education changes that occurred at Johns Hopkins (the same reformation Starr summarizes in Chapter 3). The rotation programs that were put into place at that time are the precursors of modern-day residency programs. Medical students often feel inferior to residents and senior physicians. They may even be admonished for speaking out against their seniors.

Lerner does say that many have recognized the bad effects such hierarchies have on good medical practice. Lerner provides one example, "A student recently told me he had examined a patient and concluded that she might have a severe abdominal disorder. But when he told the resident, who had seen the patient earlier and more quickly, the resident refused to re-examine the patient. He then reminded the student that while he had examined hundreds of such cases, the student had seen only a few."

Some changes have been put into place. For instance, residents and students are now to provide feedback on their rotation experience, in which they could report problems with the "hospital hierarchy." Although, I wonder if such problems can really be fixed? There seems there will always be a hierarchy, not just in hospitals, but wherever you look. I wonder if there are any true solutions to this "hierarchy problem."

As I have commented already, it seems that there is always animosity or tension between medical professionals. I'm beginning to think that such tension can never be assuaged, and it may just be a reality of the medical profession.