I cannot stand the ridiculous heirarchy. I completely agree with falling in line as far as respecting your elders goes. I don't understand, however, why we have to make it harder than it needs to be. Surgery residency/ rotations/clinicals are hard enough without us piling on a bunch of extraneous cultural norms which have nothing to do with patient care.
My take on this is that it does have to do with patient care, although indirectly.
Without a well-established hierarchy, people don't quite understand who's the Captain of the Ship and who ultimately is the voice in the room. And this is most important, in my opinion, in a trauma setting. I've seen good trauma leaders and poor trauma leaders. And the difference is how he or she establishes the hierarchy on his or her service. Those who tend to keep a tight ship with their juniors have the best run during a trauma code. Those who want to be the juniors' friends tend to have the juniors walk about and doing what they please, thus negating whatever you're trying to do for the patient actievly trying to die.
It's like the way we do the call schedule at our program. I know that its not against the rules to make someone stay for post-call clinic until noon, but if I can schedule it so that no one has to and can go home at 9 or 10am, why wouldn't I? These little extras go a long way into making surgical residency livable, and surgical residents more human in the end.
As the Administrative Chief Resident in my program, I'll give you my insight into this.
At first I believed that if you treat people more humanely, they'll eventually treat you right and do the right things for the program, the service, and ultimately the patients. They'll like you more because you are the "Chief Resident who cares."
The fact is while the majority of juniors will behave in this manner, you'll almost always have a minority of juniors who believe they're entitled to getting that post-call clinic time off. And they get used to that idea. Who can blame them? I'd LOVE to go home at 8AM or 9AM post call, but I've almost never done that in my residency. There was always something that I had to do. Loose ends, cases, clinics, conference, etc. These juniors who feel they're entitled will friggin' LOSE IT when you ask them to stay. They'll pout, make faces, and generally be counter-productive. They regress and become children.
And then what will happen? How will you, as the Administrative Chief Resident, fix the situation?
It's a tough position to be in. You certainly want the juniors to be happy, but you can't let them run the show. I'm not a fan of this saying but "when you're the zookeeper, never let the animals run the zoo."
