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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 7; 334(7596): 750.
PMCID: PMC1847867
From the Frontline


Des Spence, general practitioner, Glasgow

Increasing specialisation has upset the medical pecking order, and the guns are blazing—it is time to call a truce

“Is that you, Des?” This wasn't a séance but a random email in my mailbox. It was a friend from school with whom I had lost contact over 20 years ago. “Of course it's bloody well me” was my response. Three weeks later I walked into the restaurant and an older, greyer version of the only Mod in Orkney stood before me. Now he is a lawyer in Edinburgh, and we picked up where we left off. I reminded him of his revolting home made wine and he reminded me of the occasion following said wine when we smoked loose tea rolled in sticky labels. He jibed how he got a higher mark in maths, but I pointed out that regularly I thrashed him at cards (practical maths). But we did not brag about our professional success or how much we earnt.

Scoring points seems to matter to people, whether it be about your clothes, your car, your holidays, your weight, your house, or, of course, your children. Medicine is a hotbed of such behaviour, with superiority being our raison d'être. In the past the pecking order was clear—physician, surgeon, anaesthetist, general practitioner, and lastly the orthopedic surgeon; we all knew where we stood and enjoyed our various sniper positions. But now we have a battalion of different hospital specialists: cardiologists, reflexologists, rheumatologists, acupuncturists, boneologists—God only knows where nurse specialists fit in. The air is now so hot with sneering volleys of bullets that all the sport has gone out of it!

Is it time to put the guns down? “Your GP said WHAT?” “HOW ridiculous,” “The diagnosis was SO obvious,” and all the rest of the rehearsed expressions and phrases need to stop. No doubt, like many GPs, I have taken abuse from patients following such remarks. My clinical acumen may be C+, but most of the time I get it right. This has taught me to bite my tongue when the shoe is on the other foot and colleagues have missed a diagnosis. The reality is that illness evolves, signs change, and patients give completely different histories to different doctors—this is the essence of clinical practice. The sniping has merely served to undermine the whole profession and erode trust with the patients. We are all in this together.

My father once told me “that if you compete then you have lost.” My children have taught me a modern version of this phrase. Next time you receive that condescending letter from a colleague, hold your hands to form a W, cock your head 30 degrees, and say loudly, “Whatever.” Silly, but highly effective.

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