Medicine is full of hierarchy.  We learn it in medical school.  Third and fourth  year students wear short lab coats.  Interns, residents and staff wear long coats…or no coats.

Specialists are treated with favor by hospitals; non-specialists are supposed to make things better for specialists.  Follow the money.

Today I called to talk to an opthalmologist out of town.  We don’t have one on call…ever.  It had to do with a patient who had a chemical cleaner splash in his eye.

The operator, at the referral center, asked the secretary:  ‘Does Dr. Leap have to speak to him now?  I mean, can’t it wait till Monday?’  She was told it couldn’t.

Next, she said:  ‘I won’t get the ophthalmologist until Dr. Leap is sitting by the phone, ready to speak to him.’  Makes sense.  Most of my shift in the ER is spent napping and playing X-box.  Right.

In his defense, he was polite and helpful.  But he was part of a higher eschelon.  He was an important specialist, worth of protection and favor.  One that a lesser serf like me had better:  a) have a very good reason to bother him and b) make it as convenient as possible.

Unlike what I was once told by an administrator, as I waded through unending chaos.  ‘Dr. Leap, there’s a different expectation.  When people leave the ER, they expect to go to a better place.’


All doctors are equal.  but some are more equal than others.


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