Abstract
Your highlighting of the three deadly sins of hierarchy, etiquette and conformity as barriers to good prescribing seems highly appropriate. 1 These, of course, are not new, although hierarchy (at least in physicianly specialties) may be somewhat less of a problem than it used to be. On my first ever attachment as a student to a medical ‘firm’ (remember them?) in the Royal Infirmary of Edinburgh in the late 1970s, one particular weekly consultant round was extremely hierarchical, with the massed retinue speaking only when spoken to. Many prescribing decisions were made and carefully entered by the house officer on the drug chart at the foot of the bed. The registrar took careful notes.
When the round was finished, the ritual tea with sister drained (punctuated by classic Edinburgh senior physicianly observations – ‘I hear the porters are going to work to rule – that’ll be a big improvement’), and the consultant departed, off we went again. This time the registrar was in charge. Only selected beds were visited, no patients were spoken to, only drug charts were perused. The morning's more eccentric prescriptions were replaced with conventional treatments, and the explanations were valuable lessons in therapeutics. Indeed there were many lessons to be learnt in those hallowed corridors, not all of them available in conventional textbooks.
Where does my registrar go after my ward rounds?
Footnotes