Dr Tony McCluskey | Updates

Who's Who and What's What: Inside NHS hospitals

Dr Tony McCluskey — Thu, 23 Apr 2026 00:00:00 +0000

Doctors (Part 2)

Surgeons

There are more surgical specialties than you can shake a scalpel at. In order of decreasing IQ, they include:

Neurosurgeons, aka brain surgeons

Every young and ambitious schoolboy and schoolgirl dreams of becoming a neurosurgeon. It kind of makes sense that this group of doctors is the most intelligent, at least among the surgeons. They work on other people’s brains day in, day out, so it stands to reason they get to know what makes a really good brain tick and therefore how best to use their own. Plus, I wouldn’t be surprised if neurosurgeons didn’t occasionally augment their own processing capacity by surreptitiously slicing off the best bits of some of their patients’ brains and surgically splicing them onto their own.

Ophthalmologists, aka eye doctors

I’ve put this bunch in second place because it takes real intelligence (intelligence that I was sadly lacking in) to realise right at the very beginning of your medical training that ophthalmology consultants rarely, if ever, get called back into the hospital out-of-hours and have a lucrative private practice, to boot. They also have the least to learn. The eye is very small, after all, with only so many bits and pieces inside it. Ophthalmologists only know how to do three operations: removal of cataract, trabeculectomy (an operation for glaucoma, high blood pressure of the eye; you can go blind if it’s left untreated) and surgical extraction of a fly trapped underneath your eyelid.

Urologists, aka willy doctors

In a well-deserved third place, urologists don’t get called back into the hospital much either. They don’t just operate on willies, though. Bladders, urethras, ureters, kidneys and prostates (note, not prostrates) are all included in their remit. A friendly bunch, some of my favourite surgeons were urologists.

Otolaryngologists, aka ear, nose and throat (ENT) doctors

They operate almost exclusively on perpetually snotty-nosed kids with permanent sore throats or deaf kids with smelly pus coming out of their ears.

Cardiothoracic surgeons, aka heart doctors

The epitome of NHS heroes, this lot save lives on a daily basis. They would be higher up my list if it weren’t for the fact that they are often called back into the hospital at all hours to perform heart and lung transplants. Sharing the glory with them are the kidney and liver transplant surgeons.

General surgeons

When I was training, being a general surgeon was really a thing. They operated on gullets, stomachs, small bowels, colons, rectums, livers, pancreases, gallbladders, thyroids, arteries and breasts. They whipped off lumps and bumps from just about anywhere. They became extinct somewhere along the line, I’m not sure when exactly, to be replaced by a family of subspecialists including upper GI surgeons, colorectal surgeons, hepatobiliary surgeons, vascular surgeons and breast surgeons. A good thing, too, I suppose, because while being a jack of all trades and a master of none might be satisfying for a surgeon, you, the patient, would probably prefer to be operated on by somebody who does tons of whatever it is you’re under the knife for.

Obstetricians and gynaecologists, aka doctors dealing with women’s bits.

Very womb-centric and so only relevant to roughly half the population, these surgeons divide their time between the delivery suite and the operating theatre. In the former, they facilitate the safe arrival of new babies into the world by performing forceps deliveries and Caesarean sections. In the latter, they essentially do the opposite by performing hysterectomies and laparoscopic sterilisations.

Maxillofacial surgeons, aka max-fax.

Gluttons for punishment, these surgeons have to be doubly-qualified in medicine and dentistry, which means that by the time they’ve completed all their training, it’s nearly time to retire. I only ever anesthetised their patients when they were having their wisdom teeth extracted, so I rarely got to see them practising their obviously prodigious surgical talents on bigger stuff. If you inadvertently refer to them as dentists, prepare to have your lights punched out.

Plastic surgeons, aka cosmetic surgeons.

They make loads of dosh doing private nose jobs, face lifts and Botox injections for the rich and famous. To be fair, they also do a grand job in their NHS practice of reconstructing and repairing the victims of severe burn injuries and trauma. I should really have put them much higher up the list. I didn’t because I hated them all the years I was an anaesthetic registrar. It is a resident plastic surgeon’s job to re-implant fingers that have been accidentally torn off (it happens a lot more often than you might think). Sadly, it was my job to anaesthetise those patients. Watching somebody painstakingly operating on blood vessels and nerves I could barely see (the surgeon wore loupes, operating magnifying glasses) for hour after hour after hour throughout the entire night makes watching paint dry and grass grow palpitatingly exciting in comparison.

Orthopaedic surgeons, aka orthopods, aka bone doctors.

Although some of my best friends were, and remain, orthopaedic surgeons, all my fellow anaesthetists will agree with me that they rightly take their place at the foot of the surgical IQ league table. Orthopods are basically surgically-qualified DIYers. Forget the loupes, the small retractors, the delicate 8-0 sutures. Just give them a power drill and a hammer. No, not that one – the big one. Crash, bang, wallop! Sorted. Only an orthopod would declare in the middle of an operation that wasn’t going so well, ‘This hammer doesn’t work, get me another one.’

Like general surgeons, orthopaedic surgeons have sub-specialised. Now we have knee surgeons and hip surgeons; foot surgeons and hand surgeons; shoulder surgeons and back surgeons. The back surgeons have specialised even further into neck surgeons and lower back surgeons. If you’re ever involved in a serious road traffic collision and sustain multiple injuries, you can rest easy in your anaesthetised slumber while an entire regiment of orthopaedic surgeons put you back together again. In the fullness of time, I fully expect there to be different orthopaedic surgeons specialising in the thumb, ring finger and little pinkie.

The Service Specialties, aka ‘I didn’t know they were proper doctors’ doctors.

The hallmark of these specialists, apart from the fact that people often don’t realise, or care, that they are medically qualified, is that their patients don’t officially belong to them but are instead registered under another consultant’s name, usually a physician or surgeon.

Anaesthetists, aka sleep doctors.

The claim to fame of this group of doctors, apart from having a name nobody can spell correctly, is that they are the largest of all the medical specialties. Anaesthetists can be found in the operating theatre giving anaesthetics, on ICUs directing the medical management of critically ill patients, on the delivery suite providing labouring women with pain-relieving epidurals, running chronic pain clinics, leading cardiac arrest and other emergency resuscitation teams, as well as teaching other doctors, nurses and paramedics the principles of resuscitation. There is almost nowhere in a hospital where you won’t find an anaesthetist, and fully 70% of all hospital inpatients will encounter an anaesthetist at some point during their admission.

Most people have only the vaguest idea about what an anaesthetist does. What they do know has usually been acquired by watching TV medical dramas. An intravenous injection of a sleep draught and a whiff of gas to send the patient off, an injection of antidote and turn the gas off again to wake the patient up at the end of surgery, with nothing much else to do in between time except complete The Telegraph crossword. Surveys regularly show that nearly half of the general population does not know that anaesthetists are medically qualified. A patient once asked me what it was like to be an anaesthetist. I was delighted she was so interested and enthusiastically gave her chapter and verse about what a fascinating and professionally challenging job it was. My bubble burst when she said, ‘I think that’s something my son would like to do. He didn’t get the grades to get into university, so becoming an anaesthetist would suit him down to the ground. Can you study it at night school?’

Radiologists, aka X-ray doctors.

Never confuse the term radiologist with radiographer if you are in the X-ray department for an X-ray or scan (ultrasound, CT, MR, PET, radionuclide investigation, etc). Radiologists are doctors. Radiographers are highly qualified medical technicians, but they are not medically qualified. Radiologists, like anaesthetists, are a trifle miffed when their patients don’t realise this, particularly if they ask, ‘When will I be seeing a doctor?’

Radiologists used to spend pretty much all their time closeted in their cubbyhole, windowless offices, reporting on said X-rays and scans. However, they have reinvented themselves during my working lifetime as interventional medical practitioners, performing complex, invasive diagnostic investigations and therapeutic procedures such as coronary and cerebral angiography, balloon angioplasty, coronary stent insertion, biliary stent insertion and percutaneous nephrostomy, to name but a few.

Pathologists, aka lab doctors.

This hodgepodge of doctors can be found lurking in the mysterious clinical sciences buildings, within which the hospital mortuary is usually housed. They include chemical pathologists, microbiologists, haematologists and histopathologists.

Chemical pathologists run hospital biochemistry laboratories that analyse samples of body fluids, such as blood and urine. They advise physicians and surgeons regarding the diagnosis and treatment of patients with abnormal test results.

Microbiologists run the hospital’s microbiology and virology laboratories, which analyse samples of body fluids and tissues for bacteria and viruses to diagnose the cause of infections and determine which antibiotics and antiviral agents the organisms are sensitive to.

Haematologists run hospital haematology laboratories, the blood bank (which provides blood and blood products such as platelets, clotting factors, plasma and suspended white blood cells), and the anticoagulation clinic. Their job is to diagnose and treat disorders of the blood and bone marrow such as anaemia, haemophilia, leukaemia and lymphoma. Unlike chemical pathologists and microbiologists, who don’t get out much, haematologists like to escape the confines of their laboratories whenever they can to assess actual patients on the wards and in outpatient clinics.

Histopathologists are the doctors most people think of as pathologists. As well as examining biopsy tissue samples under the microscope for evidence of disease such as cancer, they examine whole patients, usually dead ones, in the hospital mortuary. Forensic pathology, the criminal investigation branch of histopathology, has become sexy in recent years thanks to TV programmes such as Silent Witness, Waking the Dead, and the CSI franchise, and many universities now offer BSc degree courses on criminology and forensic science. Aspiring forensic pathologists should be warned, however, that the only route to realising their dream in the UK is to spend five or six years studying at medical school, followed by ten years training as a junior doctor before finally becoming a consultant. Choosing a career as a histopathologist is a good choice if your communication skills and bedside manner are lacking. Practitioners of the dark art also have the enviable reputation of never receiving complaints from their patients or being sued by them.

Occupational Health doctors, aka Sick Leave police.

Their patients are the staff of the company or organisation they work for. Fortunately, I didn’t have much to do with ours, apart from when I had three months off work with back trouble. I wasn’t swinging the lead, either, because I ended up having a two-level discectomy and lumbar decompression/stabilisation. I suspect I would have seen a lot more of our occupational health doc towards the end of my career had I not diagnosed myself with burnout and decided to take early retirement.

Hospital Doctor Grades

If you thought the nomenclature of hospital specialists was bad enough, the grading system used to denote the seniority and status of hospital doctors is even more arcane and confusing. Terms abound, including house officers, senior house officers (SHOs), registrars, senior registrars (SRs), specialist registrars (SpRs), specialty registrars (StRs), consultants, staff grades, specialist and associate specialists (SAS doctors), specialty trainees, foundation doctors, junior doctors, trainees, core trainees, residents, locally employed doctors (LEDs) – the list is endless. Phew!

Consultants

Consultants sit at the apex of the medical pyramid. I speak from experience when I say it’s not easy to become one. First, you have to get into medical school. That’s far from a walk in the park when approaching 30,000 budding doctors apply each year for fewer than 10,000 places, never forgetting that to join the ranks of those 30,000 hopefuls, you should be expecting to achieve a minimum of three A grades at A Level, with top-tier universities also demanding at least one A* grade. Five or six years of hard slog later, you graduate with your medical degree, which is only marginally more valuable than the parchment it’s printed on as a marker of how ready you are to assume the mantle of junior doctor (oops, I mean resident doctor – see later).

If you thought it was tough thus far, the really hard work only now begins in earnest, as over the next ten years, you work long and stressful hours learning how to be a doctor, making life and death decisions regularly along the way, while simultaneously applying for, and succeeding in getting, the next job up the greasy pole. In addition, there’s studying for postgraduate examinations with a broader curriculum than most university degrees in the spare time you don’t have, paying for them, and passing them (the pass rate for most postgraduate exams is less than 50%). Shoe-horned in between all that is your private life. Work-life balance? Forget it.

Once you’ve been appointed as a hospital consultant, you’ve made it. Well done, you! Time to buy that new set of golf clubs and work out the quickest route to the private hospital where you’ll now be spending most of your time (only kidding).

I mentioned it briefly in the last blog, but it seems a good idea to clarify why some hospital doctors are referred to as ‘mister’ rather than ‘doctor’. Many people are confused on this point or simply assume that all consultants are misters. Here’s the reason.

Medical students work their bollocks off to gain the coveted title of ‘doctor’. They’re not proper doctors in the academic sense, of course. The only route to becoming a ‘real’ doctor is to undertake a PhD at university (a doctorate of philosophy degree). For example, my chemistry teacher at secondary school, Dr Slater, was a real doctor. Despite the exacting entry requirements and the long years of study, the qualification you come out of medical school with is a bog-standard Bachelor of Science degree. Your title of doctor is, therefore, honorific.

You would have thought that after sacrificing so much and working so tirelessly to be awarded the title of doctor, the last thing you would do is immediately set forth on a course of study, the end result of which would be the removal of that title. However, that is precisely what happens with surgeons. Once they pass their fellowship of the Royal College of Surgeons examination, they revert to being called plain old Mr again (or Mrs or Miss). In effect, they spend five or six years in medical school to become doctors, and then spend the next five or six years relinquishing the title. Work that one out.

Professors

A special type of hospital consultant is the professor. Starting off as a common or garden doctor, you generally get to become a professor by conducting scientific research as a university senior lecturer into a particular area of clinical interest. Over years of intense academic study, your focus of enquiry intensifies and narrows, and you come to know more and more about less and less until finally, knowing absolutely all there is to know about absolutely nothing, you are made a professor. One anaesthesia professor I worked with certainly fitted the bill. He might have been a whizz with a test tube in the lab, but he was a bloody liability in the anaesthetic room. Even as a lowly registrar, I always used to try to persuade him to catch up on his university admin in the coffee room while I got on with the job of safely looking after his patients before he killed them.

Nurse consultants

Another special type of hospital consultant is a nurse and not a doctor. Confused? So am I.

Junior doctors, residents and SAS doctors

There is a bewildering array of hospital doctors who are not consultants. Some of them are training to become consultants (trainees), others are no longer in training and work in permanent posts at other grades. It will give you a headache trying to make sense of who’s who. It’s given me a headache just thinking about what I need to say. However, I will do my best to make some sense of it.

The Firm

Back in the day, junior hospital doctors worked together in a team called ‘The Firm’. A firm comprised, in order of decreasing seniority, a consultant, senior registrar (SR), registrar, senior house officer (SHO) and house officer. Not all firms had all five ranks, though they all had a consultant and a house officer. You saw patients as a team. You had sleepless nights as a team. You lost patients as a team. You saved patients’ lives against all the odds as a team. You stressed out as a team. You consoled and supported each other when the going got tough, as a team. A firm provided a structured mentorship and apprenticeship. Being a member of a firm was key to surviving and thriving as a junior doctor. Your firm was almost like an adoptive family.

The system worked really well. Sadly, Health Secretaries, NHS managers and senior medical academics adopted a ‘If it ain’t broke, damn well fix it’ philosophy. A system which served doctors and patients well was chopped and changed so much over the years since I trained that it’s now almost unrecognisable. Here’s what we have now:

Foundation Year 1 trainees (FY1)

Basically, house officers in their first year of medical practice.

Foundation Year 2 trainees (FY2)

These would have been first-year SHOs in my day. All newly qualified doctors must follow a structured training curriculum during their two foundation years. They must demonstrate core competencies and be signed off before they are allowed to continue their medical training.

Core Trainees

After foundation training, doctors enter a core training programme to gain deeper experience in a specific field of medicine or surgery for two or three years. Such doctors are designated CT1, CT2 and CT3. FY2 doctors and core trainees together constitute old-fashioned SHOs.

Specialty Registrars (ST3-ST8)

The registrars and senior registrars (SRs) I grew up with were first amalgamated into a unified grade designated as specialist registrars (SpR). Don’t ask me why. I’m damned if I can remember, and I can’t be arsed to look it up. Some time later, the powers that be decided another tweak was needed, and SpRs became StRs (I think this stood for specialist training registrar, but once again, I haven’t the foggiest what the point of the rebranding was. Finally, we arrive at where we are now with the new, super-improved specialty registrar grade (ST1, ST2, etc, the number indicates years of seniority).

SAS doctors (Specialists, Associate Specialists)

This group of doctors is not in training. The only difference between the two designations is historical. SAS posts are taken up by individuals who, for one reason or another, do not intend to become consultants. Some of the best anaesthetists I worked with were SAS doctors.

Locally Employed Doctors (LEDs)

These doctors are also not in training. The posts are often temporary stepping stones to a training post or SAS position.

Junior doctors versus resident doctors

I never minded being called a junior doctor ten years into my training and fully sixteen years after first arriving at medical school, and I don’t recall it ever being an issue with any of my colleagues. However, times change and referring to doctors with years of experience under their belt was deemed (by the BMA, the British Medical Association, the doctors’ trade union) to be demeaning, giving the impression to the general public that junior doctors were somehow inferior and underqualified. As a result of a rebranding exercise, 50,000 junior doctors became resident doctors on 18 September 2024. On a point of order, SAS doctors were never junior doctors and are not residents.

Of course, patients don’t give a toss what moniker a doctor goes by. All they care about is whether their doctor is safe, knowledgeable, and can make them better. None of it would matter if The Firm were still there to safely manage patients and serve as both an apprenticeship-teaching model and a mutual support mechanism for the doctors. Sadly, though, not only have the titles on the hospital name badges changed, but so too has the operation of The Firm. There are too few resident doctors on duty at any one time to look after the number of acutely ill inpatients on the wards, so The Firm cannot function as it once did when I was roaming the wards.

There are several reasons for this. Back in the day, many hospital inpatients were either convalescing or were only moderately unwell. Nowadays, you virtually have to be at death’s door to merit a scarce hospital bed. Demand for hospital beds has increased almost exponentially over the years, while the availability of resident doctors has decreased following the implementation of the European Working Time Directive (EWTD). The upshot is that The Firm is a luxury the NHS can no longer afford. Instead, disparate groups of residents are thrown together almost at random to cover hospitals at night and over weekends. There is no sense of team. No mutual support mechanism. No sense of belonging. I know I sound like an old fart – correction, I am an old fart – but that’s my view, and I’m sticking to it.

Medical Students

The chances are that if you’re a hospital inpatient or outpatient, you will come across medical students eager to find something interesting in your medical history or, even better, on physical examination. As an aside, there’s an old saying known only to doctors: never be an interesting patient. If a doctor ever tells you you’re an interesting case, it’s time to make your last will and testament, if you haven’t already. You’ve either got an incredibly rare syndrome, or they haven’t a clue what’s wrong with you, despite you undergoing every test in the book. Whichever it is, the condition is invariably fatal.

Medical students are a fascinating bunch. They go through five or six years at medical school, being taught a load of stuff that may be of academic interest but doesn’t really prepare them for day one on the wards as an actual doctor. That was true for me forty-odd years ago, and I’m sure it’s even truer today. They often hunt their unsuspecting prey in packs of up to ten, taking turns to poke and prod you. It pays to clench all your sphincters tightly when the medical students are in town.

Third-year medical students are more afraid of you than you are of them, but by final year, the tables have turned. The need to examine every possible pathology in preparation for Finals supersedes all other considerations, and even if you are only visiting your Great Aunt Maud, be prepared to find yourself on the receiving end of a finger up your arse, examining your prostate gland, or your breasts being palpated in the optimistic hunt for a hitherto undiagnosed malignancy.

After qualification, the tables turn again as house officers are terrified of every patient under their care now that it’s their personal responsibility to ensure you don’t peg it.

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Who's Who and What's What: Inside NHS hospitals

Dr Tony McCluskey — Sat, 18 Apr 2026 00:00:00 +0000

A whole bunch of people work in NHS hospitals: doctors, nurses, physiotherapists, occupational therapists, radiographers, phlebotomists, cardiology and respiratory technicians, cleaners, porters and hospital managers. I debated whether to include the managers on my list. Do they do anything that could reasonably be described as work? I decided to include them in the end for completeness. They do, after all, outnumber all the other groups put together. (That statement may not be strictly accurate, but it often feels that way.)

As a patient or hospital visitor, it used to be fairly easy to tell who was who by what they were wearing. Male consultant doctors would be immaculately attired in a tailored three-piece suit, with shiny black shoes and a Rolex wristwatch. Female consultants would be wearing a smart dress or skirt, kitten heels, and tights or stockings. Junior doctors would be kitted out in something similar to their more senior colleagues, albeit less expensively, with the addition of that universally recognised sartorial totem of junior doctors the world over – the hallowed white coat.

When I first started training, nurses all wore a standard uniform, which had changed relatively little over the years. Their smart yet functional dresses were colour-coded to indicate their rank as matron, sister, staff nurse, student nurse or healthcare assistant. Nurses wore a cap, that instantly recognisable symbol of the caring profession, first introduced by Florence Nightingale. Members of all the other groups also wore characteristic uniforms, except for the managers, who would compete with the doctors for the accolade of most fashionable man or woman about town.

Nowadays, it’s Mission Impossible to work out who’s who solely from their appearance. Pretty much everybody has been forced to ditch what they used to wear by the Infection Control Police and dress in theatre scrubs instead. Is the person standing before you the consultant surgeon who’s going to be operating on your gallbladder this afternoon or the plumber who’s on the ward to unblock the ward toilet?

A cross between pyjamas and martial arts kit, theatre scrubs give the appearance that the person wearing them overslept, was in a rush and couldn’t be arsed to get changed for work. Or that the wearer is about to karate-chop their patient back into good health. When I say everybody working in your local hospital has to wear theatre scrubs, I naturally do not include hospital managers. They have retained the right to wear smart, professional-looking clothing. Conspiracy theorists would claim that the scrubs-for-all policy has nothing to do with infection control and everything to do with keeping doctors, nurses and all the other minions in their place.

Doctors (Part 1)

I’ve placed doctors at the top of the pecking order in my Who’s Who list, not only because I was one, but also because, as an erstwhile and perspicacious consultant colleague of mine often pointed out to our managers (it will come as no surprise that it was Ross Logan from my books), a hospital without doctors is a nursing home.

Hospital doctors can be broadly divided into three groups: physicians, surgeons and service providers. In this post, I’ll be talking mainly about the physicians. You’ll have to wait for the next exciting installment to find out what I have to say about the surgeons and service providers.

The cleverest doctors become physicians. It is sometimes said that physicians know everything but do nothing. This is a bit harsh, but there is a grain of truth in the old saying. You do have to be well-endowed with cortical neurones to remember the 1001 symptoms and signs of Rocky Mountain spotted fever or the almost limitless number of potential interactions between the ten different drugs a typical patient might be taking. But what’s the point when most medical diseases are relentlessly progressive, can’t be cured, and will end up killing you anyway?

Not so clever doctors become surgeons. It is sometimes said that surgeons know nothing but do everything. Well, how hard can it be to whip out someone’s inflamed appendix or cobble together your granny’s broken hip with a hammer, a few screws and a metal rod? When a trainee surgeon passes all their exams to become a fellow of the Royal College of Surgeons, they relinquish their title of ‘Doctor’ and revert to being plain old Mr, Mrs or Miss, again. It’s got something to do with bygone times when only prospective physicians went to university to become learned gentlemen. In contrast, any Tom, Dick or Harry could hack off someone’s gammy leg or drain a putrid boil poking out of someone’s rectum. Most surgeons back in the day were barbers, carpenters or butchers by trade. Not much has changed, really.

Service provider doctors are a group that includes anaesthetists, radiologists and pathologists. Not clever enough to remember the names of all those obscure diseases and which drugs won’t cure them, but far too cerebral to wield a scalpel or hammer, they spend their time helping the physicians and surgeons to look after their patients.

Physicians

Being so clever, physicians do a lot of thinking. Well, they have to do something when they’re at work. Physicians don’t operate. They don’t put people to sleep. They don’t report on X-rays and scans. There are lots of them in most hospitals, looking after patients with heart and breathing problems, diabetes, strokes, epilepsy, arthritis, over-active and under-active thyroids, and a whole host of other diseases and medical conditions that nobody but them has ever heard of – except for the poor sods who actually suffer with those diseases and medical conditions. Physicians come in more varieties than Heinz, so the following list is far from exhaustive.

General physicians.

These now rare beasts roamed the plains of the medical wards in massive herds when I was a medical student and house officer. However, they’ve since become almost extinct because they were unable to compete for hospital territory with newly evolved specialist physicians. It’s a shame, because general physicians were holistic doctors who treated the whole patient rather than just one disease or medical condition in isolation.

Cardiologists, aka heart doctors.

These are the ones to see if you’re having a heart attack or your blood pressure is through the roof. They are the experts at diagnosing heart murmurs through their stethoscopes that nobody else can even hear. That might sound impressive, but a scientific study years ago demonstrated that consultant cardiologists were no better than medical students at diagnosing valvular heart disease using only a stethoscope. Fearing for their professional reputations, cardiologists successfully reinvented themselves to become interventional cardiologists, who insert stents into the blocked coronary arteries of heart attack victims under X-ray control. Great news for patients, who avoid having to undergo major open heart surgery; less great news for cardiac surgeons.

Respiratory physicians, aka chest doctors.

They mainly look after patients with asthma and chronic obstructive airways disease. If your GP refers you to one for a flexible fibreoptic examination of your upper airways (bronchoscopy) because of a persistent cough, you might want to make sure all your affairs are in order.

Neurologists, aka nerve doctors.

You’ll find yourself under one of these if you’ve got epilepsy, Parkinson’s disease or any of a myriad number of weird and not so wonderful degenerative neurological conditions like motor neurone disease, muscular dystrophy and multiple sclerosis. Amongst the cleverest of the physicians, their talent is largely wasted because there isn’t an effective curative treatment for many of the conditions they manage. They end up spending a lot of their time reassuring battalions of worried-well patients complaining of recurrent headaches that their scans are normal and that there really is nothing wrong with them.

Endocrinologists, aka diabetologists.

They do treat other conditions apart from diabetes, but the vast majority of their patients do have a blood sugar concentration higher than a can of Coke.

Rheumatologists, aka arthritis doctors.

Every rheumatologist I ever encountered during the course of my career impressed me with their stellar intellect, encyclopaedic knowledge and quietly spoken manner. They look after people with rheumatoid arthritis and other chronic inflammatory systemic conditions. They’re the only group of doctors who routinely treat their patients with 24-carat gold. They send all their failures to the orthopaedic surgeons (see later).

Oncologists, aka cancer chemotherapy doctors.

Although definitely not the group of doctors you ever want to be professionally acquainted with, oncologists have transformed the prognosis of so many patients suffering from advanced leukaemia, lymphoma and many other cancers from being the virtual death sentence they were at the start of my training to being entirely curable in many instances.

Geriatricians, aka Department of Medicine for Older People (DMOP) doctors.

The terms geriatric patient and geriatrician are apparently no longer PC for reasons I don’t really understand, and have been replaced by ‘older patient’ and ‘physician for older people’. Given that a 30-year-old is older than an infant, does that make the 30-year-old geriatric? I digress. When I was at medical school, a professor of geriatrics (that was what he was, then) lectured us. We were amazed when he told us that, soon, a majority of hospital inpatients would be over the age of sixty-five, the threshold at the time for being labelled geriatric. It couldn’t be true, we thought. Hospitals, full to the rafters with old fogeys. He was just bigging his part, surely. But he was dead right. These unsung heroes do a fantastic job in difficult circumstances.

Paediatricians, aka kids’ doctors.

Working at the other end of the age spectrum, as a parent, you’d rather be seeing an oncologist about yourself than taking one of your children to see a paediatrician. A subset of paediatricians (neonatologists) think a 2-year-old is verging on the geriatric (apologies, I mean verging on being an older child), and limit themselves to looking after poorly newborns on the special care baby unit (SCBU).

Psychiatrists, aka mental health doctors.

As mad as the patients they treat, it’s impossible to tell the two groups apart. When I was a fourth-year medical student, I was asked by the registrar on my first day of psychiatry to assess one of the inpatients, a 52-year-old man called Colin, who had been sectioned under the Mental Health Act. I went to his room, only to find it empty. I looked in the day room, but he wasn’t there either. ‘He’s in the smoking room,’ piped up a dishevelled, ancient woman in desperate need of a shower, breaking off from watching the TV and pointing over to her left.

I wandered over in that direction and peered into the acrid cloud of smoke billowing from inside the doorway. I could vaguely make out two silhouettes sitting opposite each other, one male and the other female. ‘Could I speak to you?’ I asked the man. ‘Sure,’ he replied, stubbing out his cigarette. He followed me into the seminar room, and I got straight down to business. Half an hour later, I could well see why he had been sectioned. I had made a diagnosis of paranoid schizophrenia, complicated by manic-depression and sociopathic personality disorder. I finished my note-taking with a flourish of my pen and said, ‘Thank you very much for your time, Colin.’

‘Oh, I’m not Colin,’ he replied, ‘I’m Dr Derrington, one of the consultant psychiatrists.’

Community Medicine doctors and epidemiologists, aka your guess is as good as mine.

I’m not sure what this lot gets up to. Nobody does. Something to do with making national health policy. Their motto is: prevention is better than cure. With the UK’s spiralling prevalence of obesity, diabetes, hyperlipidaemia, hypertension, alcoholic liver disease, cancer and dementia, to name but a few conditions, there is clearly still work for them to do.

Emergency Medicine doctors, aka A&E doctors.

These doctors really are generalists extraordinaire. Working in what used to be known as Casualty, the Accident and Emergency Department, or simply A&E, but is now the Emergency Department (ED), they have to take all-comers from the victims of major trauma to timewasters with a sprained ankle; from patients with perforated appendixes and bowels to those with simple indigestion a couple of Rennies would settle; from patients who have collapsed after a brain haemorrhage to idiots complaining about the tension headache they’ve had for the past ten years and have only now decided to present to the ED with because there is nothing on the telly tonight.

You have to feel sorry for ED doctors. I know I do. They are tasked with managing an exponentially increasing number of patients while the primary healthcare and social care sectors collapse around them, often working in dilapidated buildings designed for a fraction of the number of patients flooding through the front door, with an even smaller fraction of the required number of trained staff to safely treat those patients in a timely fashion. I can see most ED doctors and nurses burning out or taking early retirement to avoid burnout, which will do nothing to help the staffing crisis.

Acute physicians, aka Medical Assessment Unit doctors.

The newest kids on the block, this specialty didn’t even exist when I started out. As long as your admission diagnosis is medical rather than surgical, acute physicians will look after you for the first 24-48 hours after you’ve finally made it through the back door of the ED into the one empty medical bed in the entire hospital (which will still be warm from the previous occupant and possibly a bit smelly if the nurses haven’t had time to change the sheets). The medical assessment ward is one level down from a High Dependency Unit, and you stay there while your acute medical condition is treated and stabilised before moving onto the cardiology ward, respiratory ward, diabetic ward, stroke unit, etc.

Intensivists, aka critical care doctors.

I’ve saved the best till last. I worked as an intensivist, spending roughly half my time caring for the sickest patients in the hospital, in the Intensive Care Unit (ICU) and the High Dependency Unit (HDU). The other half of my day job as a consultant anaesthetist was gassing patients in the operating theatre, of course. That critical care is an important part of many anaesthetists’ job descriptions is not well appreciated. A minority of the general population is aware that anaesthetists have any role in the running of ICUs, let alone that the majority of intensivists are anaesthetists.

From a patient’s perspective, needing to see me in my professional capacity as an intensivist is even worse than having to see an oncologist. Although the chances are you won’t be conscious when you meet me because you’ll be at death’s door in a medically-induced coma on full life support. It will be down to your nearest and dearest to have a few cosy chats in the Relatives’ Room with me about your chances of survival. Intensivists are right up there with the ED doctors in terms of their risk of burnout from decades of working long hours without a break, cumulative sleep deprivation and the constant stress of having to make life-or-death decisions.

Any junior doctor who decides to become an intensivist is making a really bad choice. They are always being called back into the hospital out of hours and have a curriculum of required knowledge that encompasses everything all the other medical and surgical specialities need to know plus their own Intensive Care stuff. Loads of their patient die despite their best efforts. A word of advice - become a dermatologist or an ophthalmic surgeon. Virtually no out-of-hours work and tons of private practice. Marvellous.

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Coming soon...

Dr Tony McCluskey — Wed, 1 Apr 2026 00:00:00 +0000

I will be posting a series of articles in this blog about hospital life soon. Entitled Who’s Who and What’s What: Inside NHS Hospitals, it's an insider's guide to how hospitals really work. The series will attempt to inform, explain and demystify what it is that doctors, nurses and all the other clinical specialists get up to behind your back if you're unlucky enough to be admitted to hospital.

Here are some of the topics I'll be covering...

Making sense of all the different medical and surgical specialties.

Medical terminology and acronyms explained.

The difference between a heart attack and a cardiac arrest.

How cardiac arrests are managed in hospital.

What you can do to manage a cardiac arrest until the emergency services arrive.

What's brainstem death? Surely you're either properly dead or still alive.

Organ donation.

What is general anaesthesia?

What happens on the Intensive Care Unit?

Why are some hospital doctors referred to as Mister and other as Doctor?

What's the difference between a radiologist and radiographer?

Why are there so many junior doctor grades? And why are juniors sometimes called trainees although now resident doctors is the preferred term?

Hospital managers - who are they and what do they do?

What does a coroner a do?

What goes on in the doctors' mess?

How do the different areas of a hospital work?

Why does parking your car at your local hospital cost so much and why can you never find a place to park anyway?

What is being on call like and how does it relate to stress, mental and physical health problems, and burnout?

How do I see the future of the NHS?

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Why I wrote my story

Dr Tony McCluskey — Wed, 1 Apr 2026 00:00:00 +0000

On 4 June 2020, the GMC (General Medical Council) wrote to inform me that it had erased my name from the UK register of medical practitioners and revoked my licence to practise. In other words, I had been struck off. I hadn’t done anything wrong. I had taken early retirement to escape the relentless pressure and stress of life on the NHS frontline as a consultant in anaesthesia and critical care medicine. After forty years, I was burnt out. The letter from the GMC marked the formal conclusion of my medical career. I was no longer entitled to call myself a doctor. If I did try to pass myself off as one now, I would be breaking the law.

I had a vocation to become a doctor and to minister to the ill, diseased, injured and dying from as far back as I can remember. At least, that’s what I think you expect me to say. In truth, however, I never really had that vocation thing. I hadn’t the foggiest idea what I wanted to do with the rest of my life while I was at school. Lawyer? Teacher? Particle physicist? Airline pilot? Doctor? Who knew? I certainly didn’t. I had to choose something to study at university, though, so I plumped for medicine. My decision pleased Dad, and my best friend had applied to go to medical school. Plus, doctoring was a steady job with kudos and paid well.

I was an anaesthetist for nearly all my career. Most people have only the vaguest notion of what an anaesthetist does, their knowledge acquired from watching medical dramas on TV. An intravenous injection of a sedative draught or a whiff of gas sends the patient off to sleep. At the end of surgery, an antidote is administered, or the gas is simply turned off, and the patient wakes up. In between times, there’s nothing much to do except complete The Daily Telegraph cryptic crossword. Simples. Surveys show that half of the general population does not know that anaesthetists are medically qualified doctors. A patient once asked me what it was like to be an anaesthetist. I was delighted that she was so interested, and I enthusiastically gave her chapter and verse about what a fascinating and professionally challenging job it was. My bubble burst when she remarked, ‘I think my son would like that. He didn’t get high enough grades to get into university. Being an anaesthetist would suit him down to the ground. Can you study it at night school?’

The main reason people take that view of anaesthetists stems from their ignorance of what general anaesthesia entails. As anaesthetists, we don’t help the cause by casually referring to the induction of general anaesthesia as “going to sleep”. Such language only serves to reinforce the picture of a patient dropping off into a deep, contented, peaceful snooze, little different and no more risky than taking an afternoon nap on the sofa after a huge Sunday roast. In reality, general anaesthesia has almost nothing in common with regular sleep. It is a state of deep, unresponsive coma. An anaesthetised person is as close to death as it is possible to get without actually being dead. A deeply anaesthetised subject undergoing brainstem function testing would be diagnosed as brainstem dead.

A consultant anaesthetist studies to become a doctor at medical school for five or six years and then trains in hospitals as a junior doctor for another ten years or so. I would argue that this length of time is hardly necessary to learn how to induce this state of deep, unresponsive coma, which any Tom, Dick or Harriet could do with minimal training. But it is essential to ensure you safely wake up again from your deep, unresponsive coma, and without your brain having been scrambled or you suffering any other serious adverse sequelae.

Giving anaesthetics in the operating theatre was only half of my job as a consultant. The other half was spent caring for critically ill patients in the ICU (Intensive Care Unit). Critical care is another part of an anaesthetist’s job description that is not well appreciated. Most people are unaware that anaesthetists have any role in the running of ICUs, let alone that most intensivists are anaesthetists. Anaesthetists also work on the labour ward, inserting epidurals, and in chronic pain clinics. They lead cardiac arrest teams and teach other doctors, nurses and paramedics the principles of resuscitation. In fact, there is almost nowhere in the hospital where you won’t find an anaesthetist, and 70% of all hospital inpatients encounter an anaesthetist at some point during their admission.

I thoroughly enjoyed the challenges, the job satisfaction and the privilege of being a doctor, but the positives came at a price. My wife will tell you I often wasn’t there for her or our two daughters. When my girls were growing up, I missed out on meal times, bath times and bedtime stories; playing in the park, birthday parties and days out; school concerts, parents’ evenings and sports days. My work-life balance was often unbalanced, and the years of toil took their toll. When I reached my early fifties, I realised I was suffering from burnout. Something had to change, and I made plans to take early retirement.

The last patient I anaesthetised woke up on Tuesday, 31 March 2020, at 12:45 pm. My logbook records his details: 61-year-old male; ASA III; elective ureteroscopy and laser to stone; surgeon Miss Greene; general anaesthesia; tracheal intubation; uneventful.

After his operation, I handed over his care to the recovery nurse, went to the changing room to get dressed and walked out of the hospital for the final time as a doctor. There was no fanfare, impromptu party, handshaking, retirement present or speeches. I left unnoticed as if it were any other day. But these were extraordinary times. The COVID-19 pandemic was gearing up. An awful sense of impending doom pervaded the hospital, and normal service was suspended.

Even though I was retiring, I expected to return to work after a fortnight’s break. With the anticipated tsunami of critically ill coronavirus victims rapidly approaching, my medical director had asked me if I might ‘possibly come back to help out for a bit,’ and I’d agreed. As it turned out, my further services were not required.

When I reflect on my adventures at medical school, on the wards, in the operating theatre and in the intensive care unit, and recall the patients I have been privileged to meet and care for, I can scarcely believe it all happened. There were times of great joy and times of even greater sadness. I achieved much that I am proud of. However, there were many occasions when I experienced intense frustration. Triumphs were counterbalanced by tragedies; hilarity by horror; mundanity by absurdity. Mentally replaying all these events is like watching the scenes of a movie. Those scenes are the chapters in these three books.

To answer the question posed at the beginning of this post, I decided to write my story, first and foremost, to prove to myself it really did happen. In the process of transferring my memories into my memoirs, I relived so many experiences and remembered so much I thought I had forgotten. Reading my books has helped me appreciate how lucky I was to enjoy a long and successful career as a doctor. If you read them too, I hope you'll be moved. At times, they will make you laugh, at others they will make you cry. You won't believe some of what goes on, but trust me it does! Reading my life story won't only be an entertainment, it will be an education.

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