please do not be inconsistent i find it infuriating // keep calm, work hard and STOP MIMIMI !!!
И услышал тумблер мои молитвы.
Я нашла наконец-то информацию о военных врачах в Англии.
Я даже не ссылкой, я так сюда перетащу!
читать!
As a medical student and soon to be doctor, I often watch TV programs about medicine and despair. Not because the likes of Casualty and Holby City (for those of you who don’t watch British TV these are hospital dramas) are not entertaining, but rather because they have a habit of misleading the public on what real doctors can do.
So in the spirit of annoying people with useless information – I have produced a small guide to writing fanfiction involving John Watson’s career as a doctor so that you can Brit-pick and Medical-pick your own works if you want authenticity.
Dr Watson,MD MBBS, MRCGP
Getting into the Army
Most people who eventually go on to serve in the army as doctors do so through a sponsorship program called the Medical Cadetship. You apply to the army at the same time as applying to medical school. Should you successfully gain a place at a medical school, you enter a contract with the army. They will sponsor you through all 5 or 6 years of medical school, with very general living expenses grants, and pay all the tuition fees. In return you have to serve in the army for a minimum of 7 years after graduation and the army dictates which branch of medicine you specialise in.
A note to American friends across the pond – medical school fees in the UK are no more expensive than any other university course. Given John’s age – when he went to medical school it was free. Thus John has never been burdened with student debt.
It is however interesting to think why John would volunteer to be sponsored by the army (which is the most likely route he took). We can see that he is a bit of an adrenaline addict but civilian medicine provides a healthy dose of adrenaline in most specialities. You don’t need to be sent to the sweltering hell that is Afghanistan to get a fulfilling adrenaline rush if you have a medical degree. Thus I propose that John might not have come from a long line of doctors as many people have portrayed. Perhaps he really did need the money in order to cover the cost of living in London because he comes from a lower middle class/working class background. Although many medical students have doctors in their family, most students come from a diverse range of family backgrounds.
(Side note to American friends – John has an MB not an MD. The exact letters awarded to him after graduation depend upon the medical school. In the case of Barts and the London School of Medicine it is MBBS. Although we don’t know his exact age, I assume he is over 35 years old. Thus when he started training as a doctor at age 18, he would have first trained at either St Bartholomew’s Hospital Medical College or London Hospital Medical College. The two then merged as Barts and the London in 1995. In order to get an MD in the UK you have to do two extra years of postgraduate research/study, which John may not have had a chance to do given that he’s been in Afghanistan.)
In the Army Now
All doctors in the Army are commissioned officers, so John being a Captain is not a sign that he has shown proficiency on the battlefield or even proficiency in the realm of medicine. As you progress through your medical training you get automatically promoted to the next military rank in the same way that you would get promoted from a Senior House Officer (SHO) to a Specialist Registra in the civilian word.
For those of you who are utterly confused by the “ranks” of doctors in the NHS, don’t worry even the doctors are confused but this is generally how one progresses through the ranks:
1. Two years of foundation training directly after graduation (equivalent to Interns in the US) called FY1 and FY2. When John graduated these training jobs would have been called House Jobs and he would have been called the House Officer*.
2. Spend a year or two as a Senior House Office whilst you try to get a speciality training post.
3. Get on a speciality training program e.g. GP, dermatology, renal medicine, orthopaedic surgery. You are now a Specialist Registra
4. Slog through 5 to 9 years of speciality training and become a Consultant. Everyone below Consultant level is called a junior doctor because they have restrictions on what they can do and must be supervised to some extent by their Consultant.
(*Side note - I’ve just realised that when John graduated about 12 - 14 years ago there wasn’t a foundation program! In his first two years as a junior doctor he would have been called a House Officer and then he would have progressed in the same route as today)
In the army, when you graduate you are commissioned as (I believe) a Second Lieutenant and advance through the ranks accordingly. Therefore John as a Captain may be the equivalent of a Specialist Registra. So he’s not a senior officer and he’s not a senior doctor either – he’s still in training.
Fighting in Afghanistan
John did not fight in Afghanistan - he was not a combatant.
Medical Officers in the army do not leave the base unless there are extraordinary circumstances. All their work is done in within the hospital/clinic at the base. The fan works that have John on patrol and fighting the enemy are incorrect. The medics who accompany patrols, carry weapons and patch up soldiers on field are not doctors they are paramedics (Medical Support Officers). They do not have a medical degree and are not referred to as Doctor.
Doctors in the army are all given weapons training so it’s not far fetched that John can shoot well but it’s not an essential skill set for an army doctor because 99% of the time you don’t see any action.
The only way I can think that John Watson could have been shot is if his base got overran with insurgents or he flew out to pick up a wounded soldier and then got caught in the ensuing gun battle.
Correction - there is another way for John to be totally BAMF on the battlefield, as you can read in part 2 of Semantics in Healthcare.
GP Land
All doctors must specialise in one area of medicine (General Practice is a specialism). You can no longer do general surgery or general medicine.
For those of you wondering what John specialised in – you can be sure it wasn’t trauma orthopaedics.
John was a GP* in the Army.
(*Side note - GPs are the equivalent of family doctors in the US. They see and treat minor illnesses and refer people who have major problems to specialists at the hospital.)
Why? Because he came back to London got a job was a GP. You cannot switch from one specialism to another without starting all over again in your specialist training. We know that John didn’t start his GP training from scratch because he started working in the surgery as soon as he was hired. GP trainees start off on hospital rotations before being based in a GP surgery.
He would have got a job as a locum doctor, meaning that he only came in to the surgery to fill in for doctors on leave. This is why he has so much time to run after Sherlock. He’s not a salaried GP and he’s not a partner at the GP practice. However the pay for locums is very good so he will have no problems with the bills.
In order to get a locum job John would have to be at least a specialist registra in GP training. GP practices do not employ Senior house officers or anyone more junior as locums. John would have got his locum job not through a private agency* like other temporary workers but through contact with the Primary Care Trust (PCT). PCTs control the healthcare budget for all the healthcare services in a given area. GPs are held accountable to the PCT (who give them their money) when they fail to provide an adequate health service (e.g. someone’s on maternity leave). In return they ask the PCT for locums who would be available to cover. So John didn’t just walk off the street into Sarah’s clinic, he had a prearranged interview through the PCT for that job.
*Amendment: has informed me that there are agencies that help PCTs recruit locum doctors. These agencies can sometimes be Europe-wide. In John’s case he could only legally work in English speaking countries i.e. UK and Ireland. John does mention that he went to Dublin during a week in ASiB, perhaps he was doing a locum job there? As the General Medical Council of the UK routinely share information with the Medical Council of Ireland, it’s plausible that John could get a locum position in Dublin over a weekend. Scotland, Wales and Northern Ireland are chronically short staffed.
As a locum he would have great control over the hours he worked because he is in effect self-employed. He doesn’t get an NHS pension or the same job security as normal doctors. However there is usually more demand for locum hours than locums want to provide, so John is not in danger of a shortage of work any time soon. Therefore John doesn’t have to fret about loosing his job at the surgery - he can always find another and it would end soon anyway, most locums only work in one place for a few days to weeks. The only loss to him from leaving would be that he doesn’t have a good reason to see Sarah everyday anymore.
How do you Join the Army as a Doctor?
All doctors in the army belong to the Royal Army Medical Corps (RAMC). John has a nice mug with the RAMC logo on it in ASiB when he's eating breakfast with Sherlock. All doctors belong to the RAMC and so do most (but not all) of allied health professions such as nurses, paramedics, healthcare assistants and physiotherapists.
Just to reiterate only doctors are Medical Officers: nurses, paramedics, health care assistants are Medical Support Officers. Whilst Medical Officers never fight on the frontline, Medical Support Officer do go on patrols, carry weapons and shoot at insurgents.
Amendment: currently the most well publicised way to join the army as a doctor is through the Medical Cadetship program. You apply to join the army and apply to medical school at the same time. If you are successful in both, the army generously sponsors you throughout your medical school years and then you have to work for the army for a minimum of 7 years.
John would have left medical school and been commissioned as a Second Lieutenant (the reason will be explained later). He would have spent at least the first two years of post-graduate career training in a military hospital inside the UK before specialising as a General Practioner. This training can be done on an army base anywhere in the world under the supervision of a senior GP.
What is a GP?
For anyone unfamiliar with healthcare in the UK. GP stands for General Practioner. They are the equivalent of family doctors in the US. They treat common conditions and are the first port of call for anyone who is not actually dying. They are responsible for referring patients to see specialists in hospitals if the patient's condition cannot be managed by the GP. The system is set up so that hospitals are not swamped with patients who just need some paracetmol and a lie down.
A long time ago before the NHS existed - every doctor could be a full GP as soon as they left medical school. In the last twenty years, standards of practice in General Practice have been tightening. When John graduated about 12-14 years ago, General Practice was already considered a speciality seperate from medicine and surgery. Although in reality GPs have the broadest workload of any doctor, there are many specialist skills that one must acquire in order to be a good GP.
You have to complete a set of really nasty entrance exams before starting your specialist GP training. Therefore you cannot just being work as a GP without having started or completed the GP specialist training.
Joining the Army after Qualifying as a Civilian Doctor
People have asked me if John might have joined the army after becoming a qualified doctor?
As I’m currently on placement in a military hospital*, I decided to go ask some real army doctors how they got in the program and why.
(*Side note – the military in the UK have stopped running their own hospitals. Instead they station their doctors in NHS hospitals and then send over wounded servicemen to be treated by military doctors but military doctors also treat civilian patients as well and teach civilian medical students)
Amendment: It is possible to join the army as a doctor via the professionally qualified officers training course at any stage after qualifying. However many people prefer either to join before qualifying because of the financial sponsorship or as senior doctors because specialist training posts for doctors joining after graduation are limited.
Most doctors I asked got a Medical Cadetship but there are several doctors who joined the army after qualifying because serving Queen and Country appealed to their sense of duty. These doctors joined as Consultants – i.e. they finished their training and were senior doctors. They have much more autonomy over what they do and even where they are posted to than other RAMC doctors. However they are never allowed to take a combat role because they only receive very basic weapons training (similar to that given to all new recruits). They are commissioned upon entering the army as officers, the rank depends on how long they have been a consultant. One doctors was commissioned as Colonel but he was a senior consultant when he joined.
I think there is logically enough time for John to finish his GP training and then join the army as a senior doctor but his rank as Captain would contradict this. Therefore it is possible that John might have joined up part way through his specialist training or just before he started.
Amendement: You cannot join the army after qualifying if you are/training to be a specialist in an area of medicine that the army does not need e.g paediatrics.
A GP In training
In Scandal in Belgravia John is introduced as Captain John Watson of the Northumberland Fusiliers. This is slightly odd because all doctors belong to the RAMC – they get posted to different regiments but they don’t belong to that regiment.
I need to point out thanks to arizona's timely reminder that the Northumberland Fusiliers do not exist anymore! They were amalgamated with two other regiments to form the Royal Regiment of Fusiliers in 1968! I think Moffat and Gatiss might have miss a trick here.
John Watson, most likely, started off his medical career on a medical cadetship. I have already explained in Part 1 that John would have been a GP in the army (not a surgeon).
The RAMC prefers recruiting doctors as students because the army only requires doctors who practice certain specialities. For example there are no army dermatologists or paediatricians but they have a much higher proportion of trauma, orthopaedic and plastic surgeons. Doctors who join in the army through a Medical Cadetship are then directed to specialise in a certain area. Thus if John entered the army through this route, he would have been told something along the lines of “we need more GPs – specialise in that”. Of course the military are not entirely heartless – you do apparently get some choice but not very much.
I imagine his first few years in medicine as a House Officer/Senior House Officer* before he had to specialise would have been action packed and fulfilling for John. These junior doctors straight out of medical school often do the night shifts, accident and emergency and general medical/surgical takes. You get into some truly hair raising situations that are worthy of any medical drama.
(*Side note – my mistake in Part 1: when John graduated from medical school the first two years of being a doctor were still called House Officer and Senior House Officer rather than Foundation Training)
Why did John become a GP?
So why did John decide to specialise as a GP? Well, if he joined the army during medical school they probably forced his hand in that decision but the army needs trauma surgeons too, so why didn’t John apply for that instead?
Amendment: pointed out by spiderine. John does say he is an army doctor in Study in Pink. Therefore the most likely scenario is that John was presented with a limited number of choices of what to specialise in after finishing his House Officer years. Trauma, orthopaedics and plastic surgery are all very competitive hospital based training schemes with a limited number of posts.
Medical specialitists are also needed but generally not as much as surgical ones. Long term managed of chronic illness (which is what internal medicine is all about) in soldiers is usually carried out using NHS hospitals back in the UK. The army really only need to keep their soldiers alive until they get flown back to the UK for long term treatment. Short term treatable medical issues can be dealt with by GPs actually on site in the army base, therefore they are in great demand. GPs patch up the small problems before they become big ones and keeps the army in fighting fit order.
I believe that John applied and didn't get onto the training schemes for surgery. I’m not saying he was a bad doctor but, as with any job interview, they offer jobs based on more than just your skills. You have to know the right people, make sure the bosses have a favourable impression of you. Medicine as a career (even in the meritocratic army) is still quite “cliquey”, if John did not come from a medical background it is unlikely he would be as well placed to compete against the offspring of famous surgeons or physicians. Remember there will only be a handful of jobs up for grabs and many many more hopeful applicants.
Therefore his other option was to become a GP. When John graduated (probably around 12-14 years ago) the GP training program that we have today hadn’t been established. You still needed to do some training but it was shorter than the 5 years of training that is required today to become a full GP. Therefore it is conceivable that within 4-5 years of finishing medical school John could already be a fully qualified GP.
(My personal headcanon: John went through the civilian route and when it came to applying for a speciality he didn’t get into any of the highly competitive hospital based specialities so he decided to train as a GP, got horrendously bored and went off to join the army. As he has university degree he would have been encourage to go to Sandhurst and become a commissioned officer.
This was the premise of my original post but I have amended to it fit with the theory that John admits to being an army doctor in ASiP. There might be a plot bunny in there somewhere.)
If John remained a GP how can he possibly be having nightmares about fighting in Afghanistan?
I have concluded the only way he can possibly be fighting is if John is actually a career soldier not a career army doctor. This scenario also answers many of the questions people have:
1.Why is John such a sharp shooter?
2.Why does Sarah think he’s overqualified?
3.Why invalid a doctor out of the army with limp?
Becoming the Career Soldier
My personal view is that he found GP training utterly dull. Being a GP is definitely not the most exciting career in medicine and for an adrenaline junkie like John, he wouldn’t have lasted very long before his brain started to die in despair. I believe the reality of being a GP even in the army was just not John's thing, he wanted excitement and adventure so he applied to the Royal Military Academy Sandhurst once his contract with the army had expired (i.e after 7 years) to become a career military officer.
As one doctor once said to me - you can only do this job for so long before you just need to go out and shoot something.
Sandhurst
Sandhurst is the only Army Officers’ academy in the UK; all successful applicants must go through a gruelling 44 week training program after which they become commissioned officers. These are the officers who lead troops into battle, who fight on the frontlines, who lay their lives down with their men. All army doctors undergo a short officer course at Sandhurst but I believe John joined up to be a soldier not a doctor so he would have done the whole thirty months.
here is a great BBC documentary series about life at Sandhurst
I highly recommend anyone who wants to write a realistic portrayal of John’s army days to watch this.
In addition to leadership skills, strategy and tactics, cadets at Sandhurst are also expected to have a high competency with weapons of all kinds. This could explain why John is such an amazing sharp shooter. He probably excelled at marksmanship in his time at Sandhurst. Sandhurst also has a rugby team so I guess John would be tearing his way through that as well.
Like all officers who “pass-out” of Sandhurst, John would then be properly assigned to a regiment, in his case the Northumberland Fusiliers. He would also be given the commissioned rank of Second Lieutenant (I think this is the equivalent rank to what he would have received upon graduating from medical school if he did get a Medical Cadetship).
(Passing Out - the equivalent of graduating not fainting)
Side note - Why Doctors become Officers - it's not just to confuse you!
The reason why doctors are commissioned as high level officers is mostly financial (they expect a certain pay grade and for administrative purposes they get a military rank corresponding to that pay grade). It also oils the wheels of doctor-patient relationships. Soldiers are much more likely to obey your instructions if you’re an officer. However it is important to remember that doctors never command soldiers in the field of battle or on any other military excursion (they are simply not trained to do so). If, in the unlikely event they become the most senior officer in the base, they are required to delegate command to someone more junior who actually knows something about fighting!)
Why John is Still Only a Captain
Amendment: I assume that John would loose the rank he previously attained as doctor in the RAMC. This is because that rank is purely administrative - John might well have reached Major by the time he left the RAMC but he doesn't have the military skill to command a large group of men. He would have to start off as a Second Lieutenant.
Going to Sandhurst would explain why at age 35 (or slightly more) John is still a Captain. If he graduated from medical school and then trained and worked as an army GP for 7 years before entering Sandhurst – he would be at least 30 or more by the time he gets commissioned as an military officer. He then has about 5 or 6 years serving in Afghanistan (as a full combatant) to attain two promotions from Second Lieutenant to Lieutenant and then to Captain.
John as a career military officer would have been fighting on the frontlines right beside the troops he commanded.
I imagine the army would also have made use of his medical knowledge by strapping an extra first aid kit to his back but he would not have been the Medical Support Officer (military paramedic) of his squad as that requires special training. He's probably help out when someone's wounded and when he gets back to base he may even be drafted in to run some GP clinics for people with running nosesand sunstroke.
This theory would explain why Sarah took one look at his CV and said “you’re a bit over qualified for this job”. She wasn’t talking about his medical credentials, she was talking about John having excelled at Sandhurst and being a proper military officer.
Why Invalid a Doctor out of the Army for a Limp?
This scenario also fits with why John was invalided out of the army. Army doctors who get injured on the frontlines do not get usually get invalided out of the army because their physical fitness requirements are not the same as full combat soldiers. You can still treat patients with a psychosomatic limp but you can’t lead soldiers into battle.
Amendment: If you like the idea that John is still in the RAMC at the time of his discharge the army must have either thought he was an immediate danger to his patients due to his psychological condition or possibly not going to recover mentally in a workable timeframe. Army doctors are a very valuable commodity. The army does not spend hundreds of thousands of pounds training a doctor only to discharge him for a gunshot wound that would heal up (and we have seen that John doesn't have mobility problems with his shoulder).
Wounds can be slow to heal but the army would be loosing far too much if they discharged a doctor because they didn't want to give him long enough sick leave for his arm to heal. Doctors are highly valued commodities which is why they are never put in the line of fire and the army also works very hard to retain RAMC doctors after their contract ends. They get many benefits such as free accomodation on site, bonuses and scholarships for their children to private schools.
I think it is more likely that John might have made it back to work after the gunshot wound and then had some kind of a nervous breakdown or did something untowards to one of his patients. Basically John couldn't function as doctor because of his mental not his physcial health.
So with one gunshot wound, John’s military career came to an end but he has a trade to fall back on – being a GP. It’s terribly dull but it pays his bills and always him the flexibility of running around after Sherlock.
Conclusion: John was an army doctor and a career soldier, his distinguished military service covers both spheres because he's just that awesome.
Side Note - John's legal right to practice medicine
Several people have asked how John could possibly go back to being a doctor if he's spent years training to become a soldier and then fighting in Afghanistan for even longer.
In the UK in order to legally practice medicine you must be registered with the General Medical Council (GMC). All doctors after completing their first two years as junior doctors are fully registered with the GMC. The registration never expires - no matter how long you stop practicing medicine for - you just have to pay the annual registration fee on time.
However as John hasn't practiced medicine for a few years - he must prove his professional competency. He doesn't have to retake his GP specialist exams (they are called the MRCGP and they are pretty nasty) but he does have to demonstrate to the Primary Care Trust (the NHS organisation that run all the healthcare services within the region) and the surgery where he works that he is a safe and competent doctor.
Therefore his first job at Sarah's surgery is in fact a probational post. They are observing him to see if John is fit to practice. Sadly, falling asleep during clinic is considered very unprofessional and I don't think we see John going back to work at the surgery again. If any one can find evidence that John wasn't fired for being unprofessional - it would make me very happy!
Part 3 is a short guide to how John the Army Surgeon can be made compatible with reality. It's just an interesting meta on what John went through to become an army surgeon and what he would actually do on the frontlines. I also explore why he's Dr Watson and not Mr Watson, where John actually got his medical degree from, and how John can have an MD in the modern age of medicine.
Like a Surgeon...
ACD!Watson vs BBCSherlock!John: a brief history of British Medicine – In ACD's canon John Watson is an army surgeon. It’s hard to reconcile this with the GP version of John we have in the modern adaptation. However at in the nineteenth every doctor in the army had surgical training and could be considered a surgeon.
An army surgeon at that time was a multipurpose professional. Remember this is over a hundred years ago when doctors did not specialise in a particular field of medicine. You could do both medicine and surgery (any and all types of surgery). In the modern era this is simply not possible. Orthopaedic surgeons only operate on bones; plastic surgeons only patch up skin and soft tissue. Thus one wounded soldier would need many different doctors to attend him in the present day, whereas in ACD's time one doctor would do everything for the patient including his follow up care.
In order to update John Watson - we have had to give him a speciality and the only speciality he can possible have if he managed to get a locum GP job in London is GP. This is still in keeping with his ACD canon counterpart as a GP has the broadest workload of any doctor. He would be able to treat anything from a broken finger to malaria. John would never have performed major surgery but GPs in the army do small surgical procedures that don’t involve general anaesthetics such as stitching up wounds and removing sutures.
Guide to making a John a Realistic Army Surgeon
I have had many comments from people who really want John to be an army surgeon because that’s what ACD!John did and it also opens up some awesome potential in terms of fanfiction. Who am I to deny people their ArmySurgeon!John? So here is a handy (not-too-serious) guide to making John the Surgeon as realistic as possible:
John’s GP Training – When John graduated from medical school GP training was much more loosely organised and less formal. It may be that he spent 1 or 2 years after finishing his hospital House Officer Jobs working as trainee GP. During the time John was practicing it was much easier to change from one speciality to another so he could have changed his mind and decided to become a surgeon instead.
(My headcanon – John started training as a civilian GP trainee and then decided he wanted to do surgery instead. However surgery training posts are always hard to get in NHS hospitals so John might have joined the army surgery training program instead which is less popular but has more places. Doctors can join the army in this way but you miss out on army sponsorship during your medical school. On the other hand, you do not have to sign a minimum contract to work for the army for 7 years.)
John’s Surgical Specialty - The army has a restricted range of surgical specialities – demand is very high for trauma specialists. In civilian NHS hospitals the orthopaedic surgeons operate on nearly all of the trauma cases with the help of the plastic surgeons who repair skin and soft tissue. However they mostly deal with road traffic accidents and violent crime. Gunshot wounds are very rare in UK hospitals because possession of guns is still quite rare even amongst the criminal classes. More violent crime involving weapons are committed with knives.
However in the army the major cause of trauma are gunshot wounds, shrapnel and explosions. Therefore the army requires a large number of trauma specialists. If you want John to be a surgeon – the most likely surgical speciality he would be a trauma surgeon (not an orthopaedic surgeon). Trauma specialists aim to stabilize soldiers who have sustained massive trauma as that they can be moved out of the combat zone to receive more specialist treatment.
There are other surgeons in the army and they are deployed to the front lines but they would not be responsible for operating on the soldiers who are heavily wounded. They are the second line of treatment once the trauma specialists have done their job. It is also the trauma specialists who fly out to pick up wound soldiers on the battlefield.
I have said in Part 1 that retrieving wounded soldiers may be how John was routinely sent into full combat. He would on these missions be given full body armour and stand issue weapons to defend himself. He would in some cases have had to fire back at the enemy but that would not have been his priority.
(Side Note - The army does actually employ civilian doctors in large military hospitals away from the frontline in Afghanistan. I assume that these doctors are better trained to provide the long term care that wounded soldiers need.)
Thus most of the surgeons in the combat zone would be trauma specialists and we all know John would want to be as near to the fighting as possible.
John’s surgical training – Trauma specialists cannot be easily trained in military hospitals in the UK. They really need to be in active combat zones in order to learn the skills they need. Therefore it is likely as soon as John gained a place on the trauma training program (i.e. about two or three years after graduating from medical school) he would have been sent out to whatever active war zone was available.
Although the war in Afghanistan only started in 2001 and Iraq in 2002, the British Army has been deployed as part of NATO and UN peacekeeping forces to some of the most war torn areas of the globe. Therefore John really has seen “enough [trouble] for a lifetime”. He probably was only a few years out of medical school before he was introduced to the adrenaline inducing, horrific world of real battlefield medicine.
All surgical training programs are split into Core training and Speciality training. In Core training you learn general surgical techniques that can be applied to nearly all operations. In speciality training you learn to do all the operations that your speciality routinely performs: for orthopaedic surgeons it would be joint replacements, for eye surgeons it would cataract surgery. However trauma specialists do not perform elective surgery (i.e. all their operations are emergencies) and they have to deal with a wide range of problems. Therefore their specialist training would be much like a continuation of Core training as they need to acquire a very flexible set of surgical skills.
Addition: Surgical training officially takes between 5 to 9 years but because Consultant posts are highly competitive and require a great deal of experience, in reality it takes 8 - 15 years of training. Some of these years would be used to get extra qualifications such as an MD or a PhD (yes John would then be Dr Dr. Watson) and doing fellowships abroad in different parts of the world. John probably never took time out to do a fellowship abroad as the Afghan war broke out early in his training.
In the field of trauma, experience is very important because of the emergency nature of their work and the many different types of cases they must contend with. Therefore senior doctors need many years of experience behind them in order to be competent enough to make good clinical decisions. I believe that when John got invalided out of the army he would be getting to the tail end of his training but he wouldn't be a Consultant surgeon yet.
John the Army Captain – Although in Part 1 and Part 2, I have pointed out that after 10 – 15 years of graduating from the medical school, John should have advanced further up the career ladder than Captain. As an army doctor you are automatically promoted to next military rank when you advance up the medical career ladder (see Part 1).
However John still being a Captain can simply be a sign that he is still undergoing his trauma specialist training when he was invalided out of the army. Most Registras (specialist trainees) are given the rank of Captain (therefore most doctors in the front lines are Captains). Once you finish your training and become a Consultant you would be promoted to the next military rank.
Side Note: Enlistment - John did not enlist in the army because the rank of Captain is a commissioned officer. If you enlist in the army you can only be promoted to non-commissioned officer ranks, the highest of which is Staff Sergeant. A commissioned officer was traditionally any officer with a "royal commission" i.e. a directive from the Queen. Commissioned officers were of a higher class than ordinary enlisted soldiers and their commission was used to distinguish them from the ordinary non-commissioned officers.
In the modern army all commissioned officers in the army must go through a course at Royal Military Academy Sandhurst. Professionally trained officer candidates like John would go through a shorter course as he does not actually need to lead troops into battle. However he does need to acquire some leadership skills because he is going to be a commissioned officer.
John’s actual job - As a surgical trainee John would get to do a lot of the straight forward operations on his own. He would definitely be able to extract bullets and sow up gunshot wounds without supervision as long as the bullets haven’t nicked something vital. He would probably not be doing amputations – this is the job of the orthopaedic surgeons. Instead he would be working with anaesthetists who have training in intensive care to physically stabilize wounded soldiers i.e. stop internal bleeding, extract shrapnel, sow up wounds, bandage wounds as best as possible. However in complex patients John would be the assistant surgeon to the Consultant during the operation. He would also not be in the position to make final decisions on treatment and he must defer to his superiors.
John, as a more junior member of the surgical team, would participate in retrieval missions more than the Consultant surgeons. This is because Consultants are very valuable and trainees less so. It makes more sense to send junior doctors into the combat zone because they are more expenable. Thus John would probably be pretty handy with a weapon if he has to routinely fly into combat areas, much more so than any of his bosses.
The Mystery of Mr Watson - It has been pointed out to me that John can’t be a surgeon because he would be referred to as Mr Watson and not Dr Watson. This is both true and not true (confusing right?). A surgeon only gains the right be referred to as Mr/Mrs/Miss once they pass the all important Membership of the Royal College of Surgeons (MRCS) exam. This exam needs to be completed before you become a specialist registra. Unlike medical specialities or GP, all trainee surgeons do Core training and then Specialist training, which is why it takes much longer to train as a surgeon than as a physician.
If your heart tells you John is definitely a surgeon not a GP: John could still be Dr Watson if he started a Core surgical training program but never finished it before being invalided out of the army.
Alternatively he may just like being called Doctor and he legally has the right to carry that title. It’s more a point of pride amongst surgeons that they drop their doctor title and not a legal requirement. Unless they have spent time under the surgeon’s knife, other people who meet John may not know the age old tradition of referring to a surgeon as Mister. It gets quite difficult for surgeons, particularly in their private lives, to explain to people why they don’t carry the title of doctor. It usually confuses people and makes them question whether you are “a real doctor”.
(Side note – for anyone who is interested, the reason why surgeons are referred to as Mr/Mrs/Miss is because in the eighteenth century all surgeons were “barber surgeons”. They had no formal training and where not considered part of the medical profession. The Royal College of Physicians snootily refused them all the title of Doctor. However once surgery really took off in the nineteenth century the surgeons decided they rather like being distinguished from their physician colleagues and started the practice of dropping the Dr. title from their name once they became members of the Royal College of Surgeons)
This does raise the very interesting question of just what does Miss Molly Hooper do – because she’s not a pathologist. If you’re confused by this I’ve written a nice little meta about her as well.
John's Orthopaedics Job - several people have pointed out that John’s CV (on screen caps during TBB) shows that he trained in trauma and orthopaedics. I think it says: PRHO at University College Hospital London, SHO at Broomfield Hospital Chelmsford, which is listed as "Trauma and Orthopaedics".
I understand this was drawn up by producers who probably know nothing about medicine but I have to say in this case they actually got it right.
This is a typical, typical junior doctor rotation. PRHO is his House Officer job, the first job he got straight out of medical school and SHO is his second year job. As a junior doctor you rotate through many different hospitals and specialities, moving every few months. This does not mean John specialised in orthopaedics – if he did he would have spend 7-9 years doing it instead of a few months as it says on his CV.
He might have been interested in orthopaedics but it is more likely that this was just the rotation he ended being allocated to by the hospital or Medical Deanery (the body responsible for the medical education of junior doctors within each group of hospitals). In this rotation he would have done only civilian trauma not battlefield trauma.
Give John back his MD!
John’s MD – Amendment: It is unlikely that John Watson has an MD. Doctor of Medicine is a higher qualification that requires a two year original research project, similar to that of a PhD. MD are more popular with surgical trainees, whereas medical trainees tend to favour PhDs. I believe this is because PhDs take 3-4 years of full time research. This is a long time to take out from surgical training and your surgical skills inevitably become rusty if you are not practising full time. This is often less of a problem in medicine there are less practical procedures that require muscle memory.
Higher research qualifications give specialist trainees essential research experience. Consultants, especially medical Consultants, in teaching hospitals are usually required to participate in medical research as part of their contract. Therefore having an MD or a PhD would give any specialist trainee a good foundation for their Consultant post and it is a something that most employers will look for.
However in order to do most research projects you need access to a well equipt laboratory. If John Watson was an army surgical trainee on the front line he would not have the facilities to do an MD. If John Watson is a GP trainee, he would have no need for an MD because there would be no expectation for him to conduct medical research once he has finished his training.
If anyone would like John to have an MD because it makes him sound awesome, there are some realistic ways you can do this:
If your headcanon says John is a surgeon then at some point in his training he would have got an MD. I think John would have probably investigated the best way to extract bullets from deep tissue (this is actually the title of someone’s PhD thesis) or new techniques for limb amputation. These projects could potentially be acceptable and not need to access to a research laboratory.
If you believe that John has to be GP in order for it to fit canon – John may still have an MD, though most GPs don’t go in for that sort of thing. Their top jobs are not as competitive. However a research project might have caught his eye – it would be more along the lines of biochemistry/pharmacology he’s a medical doctor not a surgeon. There might be a plot bunny in there when Sherlock stumbles upon John’s ago old dissertation and realises just how clever John really is.
John’s Medical Degree
King’s College not Barts – I have been informed by the eagle eyed trishkafibble that John’s CV says he got his MBBS from King’s College London but in the show it Sherlock says he trained at Barts!
Most likely the producers made a mistake. However I love to look for in-universe explanations for the unexplainable so here we go:
John did spend time in St. Barts Hospital but as part of his House Officer Jobs after he graduated. We can only see two jobs listed on the CV at University College Hospital and Broomfield; in reality you have at least 6 different jobs in the first two years of being a doctor. Each job would be in a different speciality and possibly in a different hospital. So it’s plausible that John worked at Bart’s with Stamford during his junior doctor days. Barts Hospital is very busy and requires a huge number of junior doctors to staff; it is also highly regarded as a teaching hospital for trainee doctors (and medical students).
Today St. Barts Hospital is used predominantly for Barts and the London medical school to train their medical students. However a small number of Kings College and University College London students end up in Barts Hospital for one or two placements. It’s all rather bizarrely organised. Don’t worry if you’re confused, the medical students are even more confused.
In ACD canon John got his medical degree from the University of London not Kings College. This squares well with his modern counterpart because John technically did get his degree from the University of London whether he went to Barts or King's College. All universities in London up until very recently issued their graduands with certificates from the University of London. It does fit quite nicely with canon, no?
Отсюда.
Я нашла наконец-то информацию о военных врачах в Англии.
Я даже не ссылкой, я так сюда перетащу!
читать!
As a medical student and soon to be doctor, I often watch TV programs about medicine and despair. Not because the likes of Casualty and Holby City (for those of you who don’t watch British TV these are hospital dramas) are not entertaining, but rather because they have a habit of misleading the public on what real doctors can do.
So in the spirit of annoying people with useless information – I have produced a small guide to writing fanfiction involving John Watson’s career as a doctor so that you can Brit-pick and Medical-pick your own works if you want authenticity.
Dr Watson,
Getting into the Army
Most people who eventually go on to serve in the army as doctors do so through a sponsorship program called the Medical Cadetship. You apply to the army at the same time as applying to medical school. Should you successfully gain a place at a medical school, you enter a contract with the army. They will sponsor you through all 5 or 6 years of medical school, with very general living expenses grants, and pay all the tuition fees. In return you have to serve in the army for a minimum of 7 years after graduation and the army dictates which branch of medicine you specialise in.
A note to American friends across the pond – medical school fees in the UK are no more expensive than any other university course. Given John’s age – when he went to medical school it was free. Thus John has never been burdened with student debt.
It is however interesting to think why John would volunteer to be sponsored by the army (which is the most likely route he took). We can see that he is a bit of an adrenaline addict but civilian medicine provides a healthy dose of adrenaline in most specialities. You don’t need to be sent to the sweltering hell that is Afghanistan to get a fulfilling adrenaline rush if you have a medical degree. Thus I propose that John might not have come from a long line of doctors as many people have portrayed. Perhaps he really did need the money in order to cover the cost of living in London because he comes from a lower middle class/working class background. Although many medical students have doctors in their family, most students come from a diverse range of family backgrounds.
(Side note to American friends – John has an MB not an MD. The exact letters awarded to him after graduation depend upon the medical school. In the case of Barts and the London School of Medicine it is MBBS. Although we don’t know his exact age, I assume he is over 35 years old. Thus when he started training as a doctor at age 18, he would have first trained at either St Bartholomew’s Hospital Medical College or London Hospital Medical College. The two then merged as Barts and the London in 1995. In order to get an MD in the UK you have to do two extra years of postgraduate research/study, which John may not have had a chance to do given that he’s been in Afghanistan.)
In the Army Now
All doctors in the Army are commissioned officers, so John being a Captain is not a sign that he has shown proficiency on the battlefield or even proficiency in the realm of medicine. As you progress through your medical training you get automatically promoted to the next military rank in the same way that you would get promoted from a Senior House Officer (SHO) to a Specialist Registra in the civilian word.
For those of you who are utterly confused by the “ranks” of doctors in the NHS, don’t worry even the doctors are confused but this is generally how one progresses through the ranks:
1. Two years of foundation training directly after graduation (equivalent to Interns in the US) called FY1 and FY2. When John graduated these training jobs would have been called House Jobs and he would have been called the House Officer*.
2. Spend a year or two as a Senior House Office whilst you try to get a speciality training post.
3. Get on a speciality training program e.g. GP, dermatology, renal medicine, orthopaedic surgery. You are now a Specialist Registra
4. Slog through 5 to 9 years of speciality training and become a Consultant. Everyone below Consultant level is called a junior doctor because they have restrictions on what they can do and must be supervised to some extent by their Consultant.
(*Side note - I’ve just realised that when John graduated about 12 - 14 years ago there wasn’t a foundation program! In his first two years as a junior doctor he would have been called a House Officer and then he would have progressed in the same route as today)
In the army, when you graduate you are commissioned as (I believe) a Second Lieutenant and advance through the ranks accordingly. Therefore John as a Captain may be the equivalent of a Specialist Registra. So he’s not a senior officer and he’s not a senior doctor either – he’s still in training.
Fighting in Afghanistan
John did not fight in Afghanistan - he was not a combatant.
Medical Officers in the army do not leave the base unless there are extraordinary circumstances. All their work is done in within the hospital/clinic at the base. The fan works that have John on patrol and fighting the enemy are incorrect. The medics who accompany patrols, carry weapons and patch up soldiers on field are not doctors they are paramedics (Medical Support Officers). They do not have a medical degree and are not referred to as Doctor.
Doctors in the army are all given weapons training so it’s not far fetched that John can shoot well but it’s not an essential skill set for an army doctor because 99% of the time you don’t see any action.
The only way I can think that John Watson could have been shot is if his base got overran with insurgents or he flew out to pick up a wounded soldier and then got caught in the ensuing gun battle.
Correction - there is another way for John to be totally BAMF on the battlefield, as you can read in part 2 of Semantics in Healthcare.
GP Land
All doctors must specialise in one area of medicine (General Practice is a specialism). You can no longer do general surgery or general medicine.
For those of you wondering what John specialised in – you can be sure it wasn’t trauma orthopaedics.
John was a GP* in the Army.
(*Side note - GPs are the equivalent of family doctors in the US. They see and treat minor illnesses and refer people who have major problems to specialists at the hospital.)
Why? Because he came back to London got a job was a GP. You cannot switch from one specialism to another without starting all over again in your specialist training. We know that John didn’t start his GP training from scratch because he started working in the surgery as soon as he was hired. GP trainees start off on hospital rotations before being based in a GP surgery.
He would have got a job as a locum doctor, meaning that he only came in to the surgery to fill in for doctors on leave. This is why he has so much time to run after Sherlock. He’s not a salaried GP and he’s not a partner at the GP practice. However the pay for locums is very good so he will have no problems with the bills.
In order to get a locum job John would have to be at least a specialist registra in GP training. GP practices do not employ Senior house officers or anyone more junior as locums. John would have got his locum job not through a private agency* like other temporary workers but through contact with the Primary Care Trust (PCT). PCTs control the healthcare budget for all the healthcare services in a given area. GPs are held accountable to the PCT (who give them their money) when they fail to provide an adequate health service (e.g. someone’s on maternity leave). In return they ask the PCT for locums who would be available to cover. So John didn’t just walk off the street into Sarah’s clinic, he had a prearranged interview through the PCT for that job.
*Amendment: has informed me that there are agencies that help PCTs recruit locum doctors. These agencies can sometimes be Europe-wide. In John’s case he could only legally work in English speaking countries i.e. UK and Ireland. John does mention that he went to Dublin during a week in ASiB, perhaps he was doing a locum job there? As the General Medical Council of the UK routinely share information with the Medical Council of Ireland, it’s plausible that John could get a locum position in Dublin over a weekend. Scotland, Wales and Northern Ireland are chronically short staffed.
As a locum he would have great control over the hours he worked because he is in effect self-employed. He doesn’t get an NHS pension or the same job security as normal doctors. However there is usually more demand for locum hours than locums want to provide, so John is not in danger of a shortage of work any time soon. Therefore John doesn’t have to fret about loosing his job at the surgery - he can always find another and it would end soon anyway, most locums only work in one place for a few days to weeks. The only loss to him from leaving would be that he doesn’t have a good reason to see Sarah everyday anymore.
How do you Join the Army as a Doctor?
All doctors in the army belong to the Royal Army Medical Corps (RAMC). John has a nice mug with the RAMC logo on it in ASiB when he's eating breakfast with Sherlock. All doctors belong to the RAMC and so do most (but not all) of allied health professions such as nurses, paramedics, healthcare assistants and physiotherapists.
Just to reiterate only doctors are Medical Officers: nurses, paramedics, health care assistants are Medical Support Officers. Whilst Medical Officers never fight on the frontline, Medical Support Officer do go on patrols, carry weapons and shoot at insurgents.
Amendment: currently the most well publicised way to join the army as a doctor is through the Medical Cadetship program. You apply to join the army and apply to medical school at the same time. If you are successful in both, the army generously sponsors you throughout your medical school years and then you have to work for the army for a minimum of 7 years.
John would have left medical school and been commissioned as a Second Lieutenant (the reason will be explained later). He would have spent at least the first two years of post-graduate career training in a military hospital inside the UK before specialising as a General Practioner. This training can be done on an army base anywhere in the world under the supervision of a senior GP.
What is a GP?
For anyone unfamiliar with healthcare in the UK. GP stands for General Practioner. They are the equivalent of family doctors in the US. They treat common conditions and are the first port of call for anyone who is not actually dying. They are responsible for referring patients to see specialists in hospitals if the patient's condition cannot be managed by the GP. The system is set up so that hospitals are not swamped with patients who just need some paracetmol and a lie down.
A long time ago before the NHS existed - every doctor could be a full GP as soon as they left medical school. In the last twenty years, standards of practice in General Practice have been tightening. When John graduated about 12-14 years ago, General Practice was already considered a speciality seperate from medicine and surgery. Although in reality GPs have the broadest workload of any doctor, there are many specialist skills that one must acquire in order to be a good GP.
You have to complete a set of really nasty entrance exams before starting your specialist GP training. Therefore you cannot just being work as a GP without having started or completed the GP specialist training.
Joining the Army after Qualifying as a Civilian Doctor
People have asked me if John might have joined the army after becoming a qualified doctor?
As I’m currently on placement in a military hospital*, I decided to go ask some real army doctors how they got in the program and why.
(*Side note – the military in the UK have stopped running their own hospitals. Instead they station their doctors in NHS hospitals and then send over wounded servicemen to be treated by military doctors but military doctors also treat civilian patients as well and teach civilian medical students)
Amendment: It is possible to join the army as a doctor via the professionally qualified officers training course at any stage after qualifying. However many people prefer either to join before qualifying because of the financial sponsorship or as senior doctors because specialist training posts for doctors joining after graduation are limited.
Most doctors I asked got a Medical Cadetship but there are several doctors who joined the army after qualifying because serving Queen and Country appealed to their sense of duty. These doctors joined as Consultants – i.e. they finished their training and were senior doctors. They have much more autonomy over what they do and even where they are posted to than other RAMC doctors. However they are never allowed to take a combat role because they only receive very basic weapons training (similar to that given to all new recruits). They are commissioned upon entering the army as officers, the rank depends on how long they have been a consultant. One doctors was commissioned as Colonel but he was a senior consultant when he joined.
I think there is logically enough time for John to finish his GP training and then join the army as a senior doctor but his rank as Captain would contradict this. Therefore it is possible that John might have joined up part way through his specialist training or just before he started.
Amendement: You cannot join the army after qualifying if you are/training to be a specialist in an area of medicine that the army does not need e.g paediatrics.
A GP In training
In Scandal in Belgravia John is introduced as Captain John Watson of the Northumberland Fusiliers. This is slightly odd because all doctors belong to the RAMC – they get posted to different regiments but they don’t belong to that regiment.
I need to point out thanks to arizona's timely reminder that the Northumberland Fusiliers do not exist anymore! They were amalgamated with two other regiments to form the Royal Regiment of Fusiliers in 1968! I think Moffat and Gatiss might have miss a trick here.
John Watson, most likely, started off his medical career on a medical cadetship. I have already explained in Part 1 that John would have been a GP in the army (not a surgeon).
The RAMC prefers recruiting doctors as students because the army only requires doctors who practice certain specialities. For example there are no army dermatologists or paediatricians but they have a much higher proportion of trauma, orthopaedic and plastic surgeons. Doctors who join in the army through a Medical Cadetship are then directed to specialise in a certain area. Thus if John entered the army through this route, he would have been told something along the lines of “we need more GPs – specialise in that”. Of course the military are not entirely heartless – you do apparently get some choice but not very much.
I imagine his first few years in medicine as a House Officer/Senior House Officer* before he had to specialise would have been action packed and fulfilling for John. These junior doctors straight out of medical school often do the night shifts, accident and emergency and general medical/surgical takes. You get into some truly hair raising situations that are worthy of any medical drama.
(*Side note – my mistake in Part 1: when John graduated from medical school the first two years of being a doctor were still called House Officer and Senior House Officer rather than Foundation Training)
Why did John become a GP?
So why did John decide to specialise as a GP? Well, if he joined the army during medical school they probably forced his hand in that decision but the army needs trauma surgeons too, so why didn’t John apply for that instead?
Amendment: pointed out by spiderine. John does say he is an army doctor in Study in Pink. Therefore the most likely scenario is that John was presented with a limited number of choices of what to specialise in after finishing his House Officer years. Trauma, orthopaedics and plastic surgery are all very competitive hospital based training schemes with a limited number of posts.
Medical specialitists are also needed but generally not as much as surgical ones. Long term managed of chronic illness (which is what internal medicine is all about) in soldiers is usually carried out using NHS hospitals back in the UK. The army really only need to keep their soldiers alive until they get flown back to the UK for long term treatment. Short term treatable medical issues can be dealt with by GPs actually on site in the army base, therefore they are in great demand. GPs patch up the small problems before they become big ones and keeps the army in fighting fit order.
I believe that John applied and didn't get onto the training schemes for surgery. I’m not saying he was a bad doctor but, as with any job interview, they offer jobs based on more than just your skills. You have to know the right people, make sure the bosses have a favourable impression of you. Medicine as a career (even in the meritocratic army) is still quite “cliquey”, if John did not come from a medical background it is unlikely he would be as well placed to compete against the offspring of famous surgeons or physicians. Remember there will only be a handful of jobs up for grabs and many many more hopeful applicants.
Therefore his other option was to become a GP. When John graduated (probably around 12-14 years ago) the GP training program that we have today hadn’t been established. You still needed to do some training but it was shorter than the 5 years of training that is required today to become a full GP. Therefore it is conceivable that within 4-5 years of finishing medical school John could already be a fully qualified GP.
(My personal headcanon: John went through the civilian route and when it came to applying for a speciality he didn’t get into any of the highly competitive hospital based specialities so he decided to train as a GP, got horrendously bored and went off to join the army. As he has university degree he would have been encourage to go to Sandhurst and become a commissioned officer.
This was the premise of my original post but I have amended to it fit with the theory that John admits to being an army doctor in ASiP. There might be a plot bunny in there somewhere.)
If John remained a GP how can he possibly be having nightmares about fighting in Afghanistan?
I have concluded the only way he can possibly be fighting is if John is actually a career soldier not a career army doctor. This scenario also answers many of the questions people have:
1.Why is John such a sharp shooter?
2.Why does Sarah think he’s overqualified?
3.Why invalid a doctor out of the army with limp?
Becoming the Career Soldier
My personal view is that he found GP training utterly dull. Being a GP is definitely not the most exciting career in medicine and for an adrenaline junkie like John, he wouldn’t have lasted very long before his brain started to die in despair. I believe the reality of being a GP even in the army was just not John's thing, he wanted excitement and adventure so he applied to the Royal Military Academy Sandhurst once his contract with the army had expired (i.e after 7 years) to become a career military officer.
As one doctor once said to me - you can only do this job for so long before you just need to go out and shoot something.
Sandhurst
Sandhurst is the only Army Officers’ academy in the UK; all successful applicants must go through a gruelling 44 week training program after which they become commissioned officers. These are the officers who lead troops into battle, who fight on the frontlines, who lay their lives down with their men. All army doctors undergo a short officer course at Sandhurst but I believe John joined up to be a soldier not a doctor so he would have done the whole thirty months.
here is a great BBC documentary series about life at Sandhurst
I highly recommend anyone who wants to write a realistic portrayal of John’s army days to watch this.
In addition to leadership skills, strategy and tactics, cadets at Sandhurst are also expected to have a high competency with weapons of all kinds. This could explain why John is such an amazing sharp shooter. He probably excelled at marksmanship in his time at Sandhurst. Sandhurst also has a rugby team so I guess John would be tearing his way through that as well.
Like all officers who “pass-out” of Sandhurst, John would then be properly assigned to a regiment, in his case the Northumberland Fusiliers. He would also be given the commissioned rank of Second Lieutenant (I think this is the equivalent rank to what he would have received upon graduating from medical school if he did get a Medical Cadetship).
(Passing Out - the equivalent of graduating not fainting)
Side note - Why Doctors become Officers - it's not just to confuse you!
The reason why doctors are commissioned as high level officers is mostly financial (they expect a certain pay grade and for administrative purposes they get a military rank corresponding to that pay grade). It also oils the wheels of doctor-patient relationships. Soldiers are much more likely to obey your instructions if you’re an officer. However it is important to remember that doctors never command soldiers in the field of battle or on any other military excursion (they are simply not trained to do so). If, in the unlikely event they become the most senior officer in the base, they are required to delegate command to someone more junior who actually knows something about fighting!)
Why John is Still Only a Captain
Amendment: I assume that John would loose the rank he previously attained as doctor in the RAMC. This is because that rank is purely administrative - John might well have reached Major by the time he left the RAMC but he doesn't have the military skill to command a large group of men. He would have to start off as a Second Lieutenant.
Going to Sandhurst would explain why at age 35 (or slightly more) John is still a Captain. If he graduated from medical school and then trained and worked as an army GP for 7 years before entering Sandhurst – he would be at least 30 or more by the time he gets commissioned as an military officer. He then has about 5 or 6 years serving in Afghanistan (as a full combatant) to attain two promotions from Second Lieutenant to Lieutenant and then to Captain.
John as a career military officer would have been fighting on the frontlines right beside the troops he commanded.
I imagine the army would also have made use of his medical knowledge by strapping an extra first aid kit to his back but he would not have been the Medical Support Officer (military paramedic) of his squad as that requires special training. He's probably help out when someone's wounded and when he gets back to base he may even be drafted in to run some GP clinics for people with running nosesand sunstroke.
This theory would explain why Sarah took one look at his CV and said “you’re a bit over qualified for this job”. She wasn’t talking about his medical credentials, she was talking about John having excelled at Sandhurst and being a proper military officer.
Why Invalid a Doctor out of the Army for a Limp?
This scenario also fits with why John was invalided out of the army. Army doctors who get injured on the frontlines do not get usually get invalided out of the army because their physical fitness requirements are not the same as full combat soldiers. You can still treat patients with a psychosomatic limp but you can’t lead soldiers into battle.
Amendment: If you like the idea that John is still in the RAMC at the time of his discharge the army must have either thought he was an immediate danger to his patients due to his psychological condition or possibly not going to recover mentally in a workable timeframe. Army doctors are a very valuable commodity. The army does not spend hundreds of thousands of pounds training a doctor only to discharge him for a gunshot wound that would heal up (and we have seen that John doesn't have mobility problems with his shoulder).
Wounds can be slow to heal but the army would be loosing far too much if they discharged a doctor because they didn't want to give him long enough sick leave for his arm to heal. Doctors are highly valued commodities which is why they are never put in the line of fire and the army also works very hard to retain RAMC doctors after their contract ends. They get many benefits such as free accomodation on site, bonuses and scholarships for their children to private schools.
I think it is more likely that John might have made it back to work after the gunshot wound and then had some kind of a nervous breakdown or did something untowards to one of his patients. Basically John couldn't function as doctor because of his mental not his physcial health.
So with one gunshot wound, John’s military career came to an end but he has a trade to fall back on – being a GP. It’s terribly dull but it pays his bills and always him the flexibility of running around after Sherlock.
Conclusion: John was an army doctor and a career soldier, his distinguished military service covers both spheres because he's just that awesome.
Side Note - John's legal right to practice medicine
Several people have asked how John could possibly go back to being a doctor if he's spent years training to become a soldier and then fighting in Afghanistan for even longer.
In the UK in order to legally practice medicine you must be registered with the General Medical Council (GMC). All doctors after completing their first two years as junior doctors are fully registered with the GMC. The registration never expires - no matter how long you stop practicing medicine for - you just have to pay the annual registration fee on time.
However as John hasn't practiced medicine for a few years - he must prove his professional competency. He doesn't have to retake his GP specialist exams (they are called the MRCGP and they are pretty nasty) but he does have to demonstrate to the Primary Care Trust (the NHS organisation that run all the healthcare services within the region) and the surgery where he works that he is a safe and competent doctor.
Therefore his first job at Sarah's surgery is in fact a probational post. They are observing him to see if John is fit to practice. Sadly, falling asleep during clinic is considered very unprofessional and I don't think we see John going back to work at the surgery again. If any one can find evidence that John wasn't fired for being unprofessional - it would make me very happy!
Part 3 is a short guide to how John the Army Surgeon can be made compatible with reality. It's just an interesting meta on what John went through to become an army surgeon and what he would actually do on the frontlines. I also explore why he's Dr Watson and not Mr Watson, where John actually got his medical degree from, and how John can have an MD in the modern age of medicine.
Like a Surgeon...
ACD!Watson vs BBCSherlock!John: a brief history of British Medicine – In ACD's canon John Watson is an army surgeon. It’s hard to reconcile this with the GP version of John we have in the modern adaptation. However at in the nineteenth every doctor in the army had surgical training and could be considered a surgeon.
An army surgeon at that time was a multipurpose professional. Remember this is over a hundred years ago when doctors did not specialise in a particular field of medicine. You could do both medicine and surgery (any and all types of surgery). In the modern era this is simply not possible. Orthopaedic surgeons only operate on bones; plastic surgeons only patch up skin and soft tissue. Thus one wounded soldier would need many different doctors to attend him in the present day, whereas in ACD's time one doctor would do everything for the patient including his follow up care.
In order to update John Watson - we have had to give him a speciality and the only speciality he can possible have if he managed to get a locum GP job in London is GP. This is still in keeping with his ACD canon counterpart as a GP has the broadest workload of any doctor. He would be able to treat anything from a broken finger to malaria. John would never have performed major surgery but GPs in the army do small surgical procedures that don’t involve general anaesthetics such as stitching up wounds and removing sutures.
Guide to making a John a Realistic Army Surgeon
I have had many comments from people who really want John to be an army surgeon because that’s what ACD!John did and it also opens up some awesome potential in terms of fanfiction. Who am I to deny people their ArmySurgeon!John? So here is a handy (not-too-serious) guide to making John the Surgeon as realistic as possible:
John’s GP Training – When John graduated from medical school GP training was much more loosely organised and less formal. It may be that he spent 1 or 2 years after finishing his hospital House Officer Jobs working as trainee GP. During the time John was practicing it was much easier to change from one speciality to another so he could have changed his mind and decided to become a surgeon instead.
(My headcanon – John started training as a civilian GP trainee and then decided he wanted to do surgery instead. However surgery training posts are always hard to get in NHS hospitals so John might have joined the army surgery training program instead which is less popular but has more places. Doctors can join the army in this way but you miss out on army sponsorship during your medical school. On the other hand, you do not have to sign a minimum contract to work for the army for 7 years.)
John’s Surgical Specialty - The army has a restricted range of surgical specialities – demand is very high for trauma specialists. In civilian NHS hospitals the orthopaedic surgeons operate on nearly all of the trauma cases with the help of the plastic surgeons who repair skin and soft tissue. However they mostly deal with road traffic accidents and violent crime. Gunshot wounds are very rare in UK hospitals because possession of guns is still quite rare even amongst the criminal classes. More violent crime involving weapons are committed with knives.
However in the army the major cause of trauma are gunshot wounds, shrapnel and explosions. Therefore the army requires a large number of trauma specialists. If you want John to be a surgeon – the most likely surgical speciality he would be a trauma surgeon (not an orthopaedic surgeon). Trauma specialists aim to stabilize soldiers who have sustained massive trauma as that they can be moved out of the combat zone to receive more specialist treatment.
There are other surgeons in the army and they are deployed to the front lines but they would not be responsible for operating on the soldiers who are heavily wounded. They are the second line of treatment once the trauma specialists have done their job. It is also the trauma specialists who fly out to pick up wound soldiers on the battlefield.
I have said in Part 1 that retrieving wounded soldiers may be how John was routinely sent into full combat. He would on these missions be given full body armour and stand issue weapons to defend himself. He would in some cases have had to fire back at the enemy but that would not have been his priority.
(Side Note - The army does actually employ civilian doctors in large military hospitals away from the frontline in Afghanistan. I assume that these doctors are better trained to provide the long term care that wounded soldiers need.)
Thus most of the surgeons in the combat zone would be trauma specialists and we all know John would want to be as near to the fighting as possible.
John’s surgical training – Trauma specialists cannot be easily trained in military hospitals in the UK. They really need to be in active combat zones in order to learn the skills they need. Therefore it is likely as soon as John gained a place on the trauma training program (i.e. about two or three years after graduating from medical school) he would have been sent out to whatever active war zone was available.
Although the war in Afghanistan only started in 2001 and Iraq in 2002, the British Army has been deployed as part of NATO and UN peacekeeping forces to some of the most war torn areas of the globe. Therefore John really has seen “enough [trouble] for a lifetime”. He probably was only a few years out of medical school before he was introduced to the adrenaline inducing, horrific world of real battlefield medicine.
All surgical training programs are split into Core training and Speciality training. In Core training you learn general surgical techniques that can be applied to nearly all operations. In speciality training you learn to do all the operations that your speciality routinely performs: for orthopaedic surgeons it would be joint replacements, for eye surgeons it would cataract surgery. However trauma specialists do not perform elective surgery (i.e. all their operations are emergencies) and they have to deal with a wide range of problems. Therefore their specialist training would be much like a continuation of Core training as they need to acquire a very flexible set of surgical skills.
Addition: Surgical training officially takes between 5 to 9 years but because Consultant posts are highly competitive and require a great deal of experience, in reality it takes 8 - 15 years of training. Some of these years would be used to get extra qualifications such as an MD or a PhD (yes John would then be Dr Dr. Watson) and doing fellowships abroad in different parts of the world. John probably never took time out to do a fellowship abroad as the Afghan war broke out early in his training.
In the field of trauma, experience is very important because of the emergency nature of their work and the many different types of cases they must contend with. Therefore senior doctors need many years of experience behind them in order to be competent enough to make good clinical decisions. I believe that when John got invalided out of the army he would be getting to the tail end of his training but he wouldn't be a Consultant surgeon yet.
John the Army Captain – Although in Part 1 and Part 2, I have pointed out that after 10 – 15 years of graduating from the medical school, John should have advanced further up the career ladder than Captain. As an army doctor you are automatically promoted to next military rank when you advance up the medical career ladder (see Part 1).
However John still being a Captain can simply be a sign that he is still undergoing his trauma specialist training when he was invalided out of the army. Most Registras (specialist trainees) are given the rank of Captain (therefore most doctors in the front lines are Captains). Once you finish your training and become a Consultant you would be promoted to the next military rank.
Side Note: Enlistment - John did not enlist in the army because the rank of Captain is a commissioned officer. If you enlist in the army you can only be promoted to non-commissioned officer ranks, the highest of which is Staff Sergeant. A commissioned officer was traditionally any officer with a "royal commission" i.e. a directive from the Queen. Commissioned officers were of a higher class than ordinary enlisted soldiers and their commission was used to distinguish them from the ordinary non-commissioned officers.
In the modern army all commissioned officers in the army must go through a course at Royal Military Academy Sandhurst. Professionally trained officer candidates like John would go through a shorter course as he does not actually need to lead troops into battle. However he does need to acquire some leadership skills because he is going to be a commissioned officer.
John’s actual job - As a surgical trainee John would get to do a lot of the straight forward operations on his own. He would definitely be able to extract bullets and sow up gunshot wounds without supervision as long as the bullets haven’t nicked something vital. He would probably not be doing amputations – this is the job of the orthopaedic surgeons. Instead he would be working with anaesthetists who have training in intensive care to physically stabilize wounded soldiers i.e. stop internal bleeding, extract shrapnel, sow up wounds, bandage wounds as best as possible. However in complex patients John would be the assistant surgeon to the Consultant during the operation. He would also not be in the position to make final decisions on treatment and he must defer to his superiors.
John, as a more junior member of the surgical team, would participate in retrieval missions more than the Consultant surgeons. This is because Consultants are very valuable and trainees less so. It makes more sense to send junior doctors into the combat zone because they are more expenable. Thus John would probably be pretty handy with a weapon if he has to routinely fly into combat areas, much more so than any of his bosses.
The Mystery of Mr Watson - It has been pointed out to me that John can’t be a surgeon because he would be referred to as Mr Watson and not Dr Watson. This is both true and not true (confusing right?). A surgeon only gains the right be referred to as Mr/Mrs/Miss once they pass the all important Membership of the Royal College of Surgeons (MRCS) exam. This exam needs to be completed before you become a specialist registra. Unlike medical specialities or GP, all trainee surgeons do Core training and then Specialist training, which is why it takes much longer to train as a surgeon than as a physician.
If your heart tells you John is definitely a surgeon not a GP: John could still be Dr Watson if he started a Core surgical training program but never finished it before being invalided out of the army.
Alternatively he may just like being called Doctor and he legally has the right to carry that title. It’s more a point of pride amongst surgeons that they drop their doctor title and not a legal requirement. Unless they have spent time under the surgeon’s knife, other people who meet John may not know the age old tradition of referring to a surgeon as Mister. It gets quite difficult for surgeons, particularly in their private lives, to explain to people why they don’t carry the title of doctor. It usually confuses people and makes them question whether you are “a real doctor”.
(Side note – for anyone who is interested, the reason why surgeons are referred to as Mr/Mrs/Miss is because in the eighteenth century all surgeons were “barber surgeons”. They had no formal training and where not considered part of the medical profession. The Royal College of Physicians snootily refused them all the title of Doctor. However once surgery really took off in the nineteenth century the surgeons decided they rather like being distinguished from their physician colleagues and started the practice of dropping the Dr. title from their name once they became members of the Royal College of Surgeons)
This does raise the very interesting question of just what does Miss Molly Hooper do – because she’s not a pathologist. If you’re confused by this I’ve written a nice little meta about her as well.
John's Orthopaedics Job - several people have pointed out that John’s CV (on screen caps during TBB) shows that he trained in trauma and orthopaedics. I think it says: PRHO at University College Hospital London, SHO at Broomfield Hospital Chelmsford, which is listed as "Trauma and Orthopaedics".
I understand this was drawn up by producers who probably know nothing about medicine but I have to say in this case they actually got it right.
This is a typical, typical junior doctor rotation. PRHO is his House Officer job, the first job he got straight out of medical school and SHO is his second year job. As a junior doctor you rotate through many different hospitals and specialities, moving every few months. This does not mean John specialised in orthopaedics – if he did he would have spend 7-9 years doing it instead of a few months as it says on his CV.
He might have been interested in orthopaedics but it is more likely that this was just the rotation he ended being allocated to by the hospital or Medical Deanery (the body responsible for the medical education of junior doctors within each group of hospitals). In this rotation he would have done only civilian trauma not battlefield trauma.
Give John back his MD!
John’s MD – Amendment: It is unlikely that John Watson has an MD. Doctor of Medicine is a higher qualification that requires a two year original research project, similar to that of a PhD. MD are more popular with surgical trainees, whereas medical trainees tend to favour PhDs. I believe this is because PhDs take 3-4 years of full time research. This is a long time to take out from surgical training and your surgical skills inevitably become rusty if you are not practising full time. This is often less of a problem in medicine there are less practical procedures that require muscle memory.
Higher research qualifications give specialist trainees essential research experience. Consultants, especially medical Consultants, in teaching hospitals are usually required to participate in medical research as part of their contract. Therefore having an MD or a PhD would give any specialist trainee a good foundation for their Consultant post and it is a something that most employers will look for.
However in order to do most research projects you need access to a well equipt laboratory. If John Watson was an army surgical trainee on the front line he would not have the facilities to do an MD. If John Watson is a GP trainee, he would have no need for an MD because there would be no expectation for him to conduct medical research once he has finished his training.
If anyone would like John to have an MD because it makes him sound awesome, there are some realistic ways you can do this:
If your headcanon says John is a surgeon then at some point in his training he would have got an MD. I think John would have probably investigated the best way to extract bullets from deep tissue (this is actually the title of someone’s PhD thesis) or new techniques for limb amputation. These projects could potentially be acceptable and not need to access to a research laboratory.
If you believe that John has to be GP in order for it to fit canon – John may still have an MD, though most GPs don’t go in for that sort of thing. Their top jobs are not as competitive. However a research project might have caught his eye – it would be more along the lines of biochemistry/pharmacology he’s a medical doctor not a surgeon. There might be a plot bunny in there when Sherlock stumbles upon John’s ago old dissertation and realises just how clever John really is.
John’s Medical Degree
King’s College not Barts – I have been informed by the eagle eyed trishkafibble that John’s CV says he got his MBBS from King’s College London but in the show it Sherlock says he trained at Barts!
Most likely the producers made a mistake. However I love to look for in-universe explanations for the unexplainable so here we go:
John did spend time in St. Barts Hospital but as part of his House Officer Jobs after he graduated. We can only see two jobs listed on the CV at University College Hospital and Broomfield; in reality you have at least 6 different jobs in the first two years of being a doctor. Each job would be in a different speciality and possibly in a different hospital. So it’s plausible that John worked at Bart’s with Stamford during his junior doctor days. Barts Hospital is very busy and requires a huge number of junior doctors to staff; it is also highly regarded as a teaching hospital for trainee doctors (and medical students).
Today St. Barts Hospital is used predominantly for Barts and the London medical school to train their medical students. However a small number of Kings College and University College London students end up in Barts Hospital for one or two placements. It’s all rather bizarrely organised. Don’t worry if you’re confused, the medical students are even more confused.
In ACD canon John got his medical degree from the University of London not Kings College. This squares well with his modern counterpart because John technically did get his degree from the University of London whether he went to Barts or King's College. All universities in London up until very recently issued their graduands with certificates from the University of London. It does fit quite nicely with canon, no?
Отсюда.
@темы: John, реальная жизнь, for future references