It is an oft-quoted (actually misattributed) adage in medicine that if you want to establish a diagnosis you should adhere to Sutton’s Law. Willie Sutton was a bank robber who was famously quoted as replying to a reporter’s question of why he robbed banks with “Because that’s where the money is”. So too, it is suggested, should doctors do the same when attempting to make a diagnosis. However, where the money is likely to be depends greatly upon you ask. The morning medical handover can be a nerve-wracking affair. Two poor night medical registrars have been frantically writing or typing away all night, admitting all manner of medical patients to the hospital, with the end of the 12 to 14 hour shift a mere hour away. But barring their way, a room or possibly a small lecture theatre full of doctors and medical students waiting to dissect the contents of their sleep-deprived speech with swift ruthlessness. Once a quorum of day-time doctors, invariably carrying take-away and keep cups of their warm beverage of choice, has filled the room the command to start is given and the battle begins. It really is a battle, the night doctors fighting to ensure their assessments of the patients are accepted without too much fuss, the different medical teams battling to keep the numbers on their lists down by suggesting certain patients would be better managed under other units, and everyone waging a personal war against sleep. With each patient the night registrars attempt to give a cohesive and comprehensive picture of why they managed the patient the way they did with convention dictating, for good reason, that they start with the history, move through their examination findings, blood test results, and imaging analysis before describing their plan. Depending on the set-up a variable amount of this information will at the same time be projected onto a screen for all to see the truth of the matter for themselves. A curious pastime therefore exists in watching the eyes tracking frantically over the information, some attempting to catch the registrars out in a misstatement, others trying to find new problems, and still others simply professionally curious. It is a truth universally acknowledged that before they reach the end of their presentation the night doctors will be interrupted. The temperament of the most disgruntled senior doctor in the room will usually determine how aggressively and early this occurs. Once the ice is broken other more mild-mannered physicians will add their questions and comments to the mix. Many of these comments will be along the lines of “Could you go back to the x-ray?”, or “What was the haemoglobin again?” and belie what that doctor considers most important and likely to give the team the answer. Of course an endocrinologist will always want to know the blood sugar and a nephrologist will always be interested in the kidney function. But if it’s a shortness of breath case there’ll be one doctor who always asks for the chest x-ray and another who swears by the blood gas results as the best way to determine the cause. This all reflects differing beliefs of “where the money is” and the relative value of some parts of the diagnostic process over others. Which can all be very confusing for the poor junior doctors who are left with the impression that the money is wherever you want it be so why attempt to abbreviate the diagnostic process in the first place, cursing Sutton all the time. In truth Willie Sutton actually never made the statement now famously attributed to him, by his own
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When a federal election is in the air there's an awful lot of thinking about where people stand, within their party, in the polls, the estimation of the public, or historically. But in amongst all this noise there was a plaintive cry from one media personality, whose membership of an exclusive club, which included most elected representatives, was not renewed. The intriguing series of articles that covered this story all seemed to suggest the same thing, that membership of such a club was a valuable marker of one's position in the Australian strata, and its loss would be keenly felt. Position in a social hierarchy is as old as humanity itself. Sure, the way it is measured has changed over the millennia, from prowess in war, to achievement in business, the arts, or science. But the concept is inextricably human. The ancient Romans termed it dignitas, a measure of a citizen's worth in the eyes of their peers, and thus their ability to both command influence and demand respect. With the explosion of human endeavour in recent centuries there are now innumerable dominance hierarchies (or competence hierarchies if your social-liberal orientation prefers) that one may, and indeed must, participate in. The corporate ladder is measured by position and remuneration, the scientific pecking order by publications and research output, the performing arts by top music charts, television ratings, box office takings, and oh so many awards of varying value and influence. But regardless of one's primary field, there is always a desire to be able to compare oneself to anyone. Print media abounds with lists of the 'most influential people of the century', 'most successful people of the decade', or even 'most important people of the year'. In practice, however, how does a successful sports star compare themselves to a chart-topping artist, or a blue-chip CEO compare with a leader of Government? I posit that meta-hierarchies exists, or a hierarchy of hierarchies if you will, where geographically co-located people have their own way of identifying/signalling their relative dignitas. These undoubtedly change with time and location, and may be vastly different across time and space depending upon the context-specific social mores. I hypothesise that the Melbourne, Australia meta-hierarchy goes something like this:
This is of course a traditional view and ignores the modern social economy that is measured in Facebook followers, Twitter re-tweets, Youtube views, and Instagram likes. But for now at least I suspect this is largely how the oldies compare appendages, so to speak. |
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