The tyranny of timelines: On the manufactured deference to medical seniors

Deep within the strata of medical institutions is a peculiar and persistent pathology — one not found in the annals of Harrison’s or Robbins’ but insidiously embedded in our institutional psyche: the sanctification of seniority into unchallengeable supremacy. 

It masquerades as discipline, cloaks itself in protocol, and thrives on fear — not the rational fear of clinical error or ethical lapse, but a fear far more primitive: of offending those who arrived before us. 

The term 'senior' is, by definition, a temporal designation — it connotes nothing more than chronological precedence. A few years earlier into the MBBS corridor, an earlier entry into service, perhaps an additional decade of clinical exposure. 

These are undeniable facts of professional progression, and in their rightful place, they unequivocally deserve acknowledgement, maybe even admiration, where accumulated wisdom, demonstrated resilience, or exceptional clinical acumen has been earned. 

But what they decidedly do not deserve — and what they have unreasonably come to expect — is submission. 

The tragedy lies in how effortlessly deference transmutes into dread. In too many state hospitals, especially at the peripheral level, one finds junior doctors contorting their personalities, tempering their voices, and curating their language to avoid the glacial gaze or wrathful silence of a 'respected senior'.

These rituals of artificial reverence are not born out of culture or conscience. They are survival tactics in a system where disapproval from above can translate to memos, stagnation, or social alienation — not due to incompetence, but because one dared to speak plainly, or worse, excel publicly without prior permission. 

I have observed — and personally endured — the fallout of choosing forthrightness over false decorum. In this inverted moral universe, accomplishments outside the traditional medical realm, especially in literature, public discourse, or system critique, are viewed not as enrichment but as deviance. 

The silent message is clear: Stay in your lane. Speak when spoken to. Praise upward; question downward. 

Let it be said without ambiguity — respect is earned, not demanded, and certainly not extracted through fear. To respect a senior for their insight, for their resilience, or for the clinical grace they embody is an honourable instinct. But to tiptoe around them, to flatten one's opinions in meetings, to disguise insight as ignorance to keep their egos untarnished — this is nothing short of institutional cowardice masquerading as civility. 

We must begin to name this culture for what it is — not tradition, but the tyranny of tenure. Not mentorship, but monarchy by seniority. And we must teach our young professionals — interns, junior doctors, probationers — that they owe their seniors dignity, not docility; that truth does not require authorisation, and that the voice of integrity, even if junior in years, is not junior in value. 

Medicine is not a feudal system. It is not a palace with vassals and courtiers. It is a collegium of minds united by purpose, not pecking order. If we are to rescue the profession from its current crisis of morale and meaning, we must begin by liberating it from this despotic reverence for hierarchy. 

Let the next generation walk into hospitals not with hushed voices and lowered eyes, but with the spine of self-respect and the soul of sincerity. Fear is not a virtue. It is a symptom of systems that no longer deserve to remain unquestioned.

Dr Anoop Prathapan is a General Practitioner based in Thiruvananthapuram. He is a writer, subtitle artist, and published translator.

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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