To the Editor: Attending, as a “junior” outpatient rather than a Senior Physician, the hospital where I once worked has been a quantum change that has been both fascinating and instructive.

There is a strict hierarchy among us out-patients. Having only my second intraocular injection makes me junior to the stout, slightly dyspnoeic man opposite, who is having his sixth. His status is increased by his wife’s attendance at the Cardiology Clinic. The elderly married couple nearby gain much prestige by having to leave their farm at 6:00 am and drive more than 150 km to the hospital. The rising cost of petrol is a worry, but while here they will take the opportunity to visit their married daughter who lives in the city near the hospital. Pride of place goes to the man who proved the doctors wrong — “They said I’d die two years ago and look at me now!”

The staff do not escape scrutiny. Dr A is good but doesn’t talk much. Dr B is a lovely lady and her new hairdo is a big improvement, although the green dress is not quite right for her. Dr C is elderly and worried about his wife’s illness. Dr D is extremely good but is always running late. It’s best to get him, even if you have to wait. The appointment clerk on the left is more willing than the other clerk to give you the time and date you prefer for your next appointment.

It is a new insight into the social dynamics of the hospital, even if it comes some years after I have retired from active duty. But clearly, all hospital administrators would gain much by spending six months as an anonymous outpatient.