Why do different medical specialties not get on?

Medicine is full of different tribes: the A and E tribe, the anaesthetic tribe, the ITU tribe, the surgeons and the medics etc.

We are all meant to work together for the patient, we should be helpful, kind and civil to each other but we’re not.

We turn into Game of Thrones characters, each looking to get ultimate control and power over the hospital so things can been done in “our way”, especially when Winter is Coming.

As juniors we move through these tribes, being one month a surgeon, then a medic, then A and E. We should feel able to unite the tribes and put an end to the bloodshed. We don’t though, like Theon Greyjoy taking Winterfell to impress his father, we immediately and fully change tribes.

It’s because as juniors we are truly nomads. Leaving the big medical school with all our friends, we are alone and we cling to whatever we can find.
When we join our first team we immediately want to be part of it, we need a place in the hospital, it is that evolutionary need for protection and a place in the world. So we join the tribe completely and unquestionably.

I remember immediately thinking everyone apart from urologists were idiots who could not put catheters in right and that if we were not going to do an operation then the medics should immediately take over their care.

Then the change over day comes, we are immediately replaced and no one cares, we no longer belong because everyone knew we were just passing through. So we grab on to the next tribe and change our behaviour to match the culture of that tribe.

We feel, to stay in the group, we have to put down the other tribes to increase our importance in our own tribe.

This goes to the extreme; as an anaesthetist I have a close working relationship with a certain surgical SHO, yet while doing a Locum in A and E the same SHO was rude over the phone to me, as I was considered to be in the A and E tribe.

The way I see to solve this issue is the creation of the Supertribe, a mixture of groups, a bit like McBusted. This is normally created naturally between ITU and anaesthetics due to the continued crossover of personnel but it needs to encompass all specialties and really the entire hospital.

If the tribe was the entire hospital then there would be no animosity between specialties and the place would probably run more smoothly. We need more activities to include the whole hospital and a complete hospital culture of one tribe. We should train together like in the treats course and socialise together so that we can ultimately work together for the patient.

Steve Young
@steveyoungmedic

See also:
10 Reasons why medical teams don’t work
Victoria Brazil’s SMACC talk