Semantics of Healthcare 4 - Meet Miss Molly Hooper
In this meta I explore:
Feedback always welcome.
The Royal College of Pathologists does not approve…
All pathologists in the UK are qualified doctors. Pathology is a specialty of medicine that requires speciality training of 4-6 years depending on which branch of pathology you choose to specialise in. All potential pathology trainees must have completed Core Medical Training programs beforehand and received their membership of the Royal College of Physicians (MRCP).
Pathologists have their own Royal College and administer their own fellowship exams (FRCPath) for everyone who wants to be consultant pathologist (i.e. the top job).
Therefore if Molly was a fully qualified pathologist she should be address as Dr. Hooper. To give her full qualifications she should be Dr. Hooper MBBS, MRCP, FRCPath
However she is referred to as Miss Molly Hooper. There are three ways one can interpret this:
Possibility 1 - Molly’s actually a real pathologist
This is probably much more likely than the other scenarios because she certainly spends a lot of time looking like a pathologist.
There are four specialities within pathology:
If you’ve ever had a blood test or a biopsy: the pathologists are the people who actually do the tests and write the report that your doctor gets. They have very little patient contact, which suits some people, and spend nearly all their time working in a laboratory environment.
Side note - White Coat Syndrome
Technically patients in the UK can’t get white coat syndrome because their doctors do not wear white coats anymore and have not done for nearly ten years. White coats are not the most hygienic of clothing, given that they have long sleeves that can trail all over the patient. The NHS regulations now state all medical personnel who come in contact with patients must be “bare below the elbow”. Ties have also been banned in hospital because they can also pose an infection risk.
Nurses all have uniforms that signify their rank but doctors can wear whatever they like as long it looks professional. However I know one doctor who likes to wear colourful shorts in summer and his patients love it!
So fanfiction writers: please do not have John wandering around a hospital wearing a white coat. He should be in a shirt with the sleeves rolled up and not wearing a tie.
Going back to Molly - as a pathologist she will be wearing a lab coat because she works in a lab most of the time. She also appears to spend a lot of time in the morgue and knows who all the dead bodies are. Therefore it is more likely that she is a histopathologist because they end up doing the post-mortems as well as looking at specimens sent from live patients.
Histopathologists also do forensic post-mortems (which can explain why two murder victims were in Molly’s morgue in TBB). However the procedure for a forensic post-mortem is very stringent and requires special training. If you think Molly is a consultant pathologist (i.e. a senior doctor) she might be doing the hard post-mortem cases: the unexpected and suspicious deaths.
However the police force also employs fully qualified pathologists. In a big force like the Met, they would have their own resident pathologists (who are doctors) doing their forensic post-mortems. Police forces don’t usually have morgues, though, so this may be why they needed to store the bodies in Bart’s. Additionally at that point in TBB when we see the bodies - foul play had not been suspected and NHS pathologists do end up doing post-mortems for suicides.
Having said this, post-mortems do not take up all of Molly’s time. A large bulk of her work is actually preparing and examining specimens from both the dead and the living under a microscope. Biopsies and excisions from any organ in the body need to be reviewed and reported on by histopathologists.
Pathologists usually work very sociable hours. Their patients/specimens are not going anywhere - mostly because they are dead. However there are always pathologists on call because there are genuine emergencies when a result is needed immediately perhaps for the patient’s individual treatment or public health concerns. It is not far-fetched that Molly would be on call at Christmas. She does not need to actually stay in the hospital nor does she have to put her social life on hold. She just needs to turn up if there is an emergency sample to be processed. Therefore, I think she wouldn’t have really minded going into hospital again to show Sherlock Irene’s “corpse”. She was mentally prepared to go into hospital at a moment’s notice anyway.
Side Note - what Sherlock really did at Uni…
Given the types of experiments Sherlock tends to run - I often wonder if Sherlock actually did Natural Sciences at Cambridge instead of just Chemistry in another University (Natural sciences in Cambridge form is not offered anywhere else).
In Cambridge the Natural Sciences course contains modules from all branches of science: physics, chemistry, biology, geology, material science etc. The Natural Scientists (Natscis) all have to do Chemistry in their first year regardless of what other modules they choose. In their second and third years they get to choose just the bits they like. In my personal opinion (and given there is a head in the fridge) Sherlock specialised in pathology.
The pathology course at Cambridge is the same course that the medical students take. There are lots of lab practicals, which teach students how to stain for bacteria, test for toxins, culture bacteria/viruses and examine post-mortem slides and gross anatomy. No practicals that involve microwaving eyeballs or saliva coagulation, though.
Sherlock uses all these skills in his work as a detective. For example: he manages to identify C. botulium on Carl Power’s shoelaces.
(By the way, that image we get shown is not actually of Clostridium botulium. It is also an electronic microscopy picture that you have to use a huge machine to generate. Under a light microscope: C.botulium spores have to be stained before you can see them. However it is not far-fetched that the spore can still be on the laces after all these years. Bacillus anthracis causes outbreaks decades after the initial outbreak)
This is what Clostridia actually look like stained properly under a light microscope (they are the blue rods with white heads).
For a more detailed exploration of Sherlock's university life please read: Oxbridge - Camford? Sherlock's University Life.
Possibility 2 - Molly’s a morgue technician
Pathology labs and by extension the morgue employs lots of technicians. They generally keep the equipment in order and file away specimens if need be (this actually includes corpses). In haematology labs they may run samples of blood test for the doctors and perhaps fill in routine paper work.
Otherwise they don’t make any of the decisions about what happens to specimens/corpses, nor do they do any medical stuff such as post-mortems. However they do have the same unrestricted access to the lab/morgue where they work.
This is consistent with what we see Molly doing during the TV series but this explanation is a bit boring.
Possibility 3 - Miss Molly Hooper, the surgeon
This is personally my favourite interpretation - I’m all for women in surgery because there’s current not enough!
If Molly is rightfully addressed as Miss Hooper, she would have already passed her Membership of the Royal College of Surgeons (MRCS). This exam allows her to progress into a surgical speciality training program. We have no clues as to what kind of surgery Molly might have chosen to specialise in but we can deduce something from the fact she is spending a lot of time looking like a pathologist.
Getting a consultant post in surgery is very hard - many surgical trainees who want a post in big teaching hospitals like Bart’s take time out to do either a PhD or an MD. They are both research degrees but an MD takes less time than a PhD.
In order for the extra degree to count in a job interview, you need to do something related to your surgical speciality. Orthopaedic surgeons like to investigate how bones heal, for example.
Molly is wandering around the morgue in a lab coat because she's doing a research project in the pathology department as part of her surgical training.
The fact that Molly is doing a (most likely) histopathology project can suggest anything. However she does spend a lot of time in the morgue, although we never see her doing a post-mortem. I personally think that Molly is doing a research project into surgical mortality.
The surgical specialities with the highest immediate mortality rates are: colo-rectal surgery, cardiac surgery and heptobilliary surgery. These usually involve very large operations that require anastomoses (joining up) of bowel or blood vessels. Patients can die on the table due to blood loss/shock or immediately afterwards due to short term complications like infection, anastomosis failure, blood loss etc.
If you want to imagine Molly doing lost of post-mortems in the morgue, her project may be investigating the causes of anastomosis failure in patients who have died in hospital. She may be training to be an, upper GI, colo-rectal, hepatic or heptobiliary surgeon.
Most surgeons doing a PhD also do on call rotas at the hospital they are working. This may explain why Molly appears to be in the hospital any time of the day or night. She’s not actually doing her project but helping out with emergency cases.
This puts a whole new slant on Molly’s character. Being a woman in surgery is difficult because it is still a male dominated profession. It is also extremely hard work. I personally think Molly is an very strong character despite her reactions to Sherlock. Sherlock is not a patient or a colleague, he is her unrequited love interest. Just because Molly occasionally goes a bit soppy over Sherlock and lets him walk all over her doesn’t mean she isn’t capable of making tough decisions or leading a team of doctors.
Faking Sherlock's Death
Good news to all those fanfic writers out there: Molly could totally forge Sherlock's death certificate (as long as she's a doctor).
Any qualified doctor is allowed to write a death certificate. Usually in the middle of the night, it's the most junior doctors who get the grisly task of pronouncing someone dead and then filling out the form. If they can do it, everyone more senior is able to as well regardless of what speciality they are in.
If a body is bought straight into the morgue off the street, it will be the pathologist-on-call's duty to certify death. If Molly is a pathologist she can easily arrange to be on call during Sherlock's suicide attempt. If Molly is a surgeon doing a research project she may still be able to do this.
Doctors doing PhDs "moonlight" as a great number of things for money. PhD funding is about minimum wage and doctors are used to living on much bigger pay cheques. Being on the pathology on call rota is actually a much easier (if less well paid) way to spend your time. Pathologists do not have to be in the hospital during evening and weekends if they are on call, unless an emergency happens. Surgeons below the level of Consultant must stay in the hospital because they will be the person responsible for all the surgical patients in many different wards.
The pathology department could be practically begging Molly to do some on calls to take the pressure off everyone else. This might have been very attractive to Molly as you don't actually have do every much as an on call pathologist. There are very few occasions when you have to examine a specimen right now. All you have to do is prioritize the list of jobs received over the on call period for the person coming into work the next morning.
The Non-existent Post Mortem
Many fanfic writers have been quite caught up in how Molly is going to fake Sherlock's post-mortem.
The answer is: she doesn't have to.
Post-mortems are usually only carried out in the cases of unexpected death, suspicious deaths or undetermined cause of death.
There are two distinct types of autopsy:
Therefore as long as Mycroft does not demand an autopsy and the police decide the carnage at Bart's was a double suicide, there is no need for Molly to even produce a post-mortem report.
If Mycroft is in on the whole thing, Molly might not even need to produce a body. A simply death certificate filed correctly will be more than enough.
Other Parts in the Series:
Part 1 - Exploring Dr Watson's Army Career
Part 2 - How can an Army GP be fighting on the front lines? John's Dual Career
Part II.I - Dr Watson: scientist and psychiatrist
Part 3 - Guide to making John a Realistic Army Surgeon
- Why Miss Molly Hooper cannot be a pathologist
- If Molly is really Dr Hooper what kind of pathologist she would be and what she would actually do.
- What else Molly could be doing in a morgue - technician or surgeon?
- How Molly might have faked Sherlock's death
Feedback always welcome.
The Royal College of Pathologists does not approve…
All pathologists in the UK are qualified doctors. Pathology is a specialty of medicine that requires speciality training of 4-6 years depending on which branch of pathology you choose to specialise in. All potential pathology trainees must have completed Core Medical Training programs beforehand and received their membership of the Royal College of Physicians (MRCP).
Pathologists have their own Royal College and administer their own fellowship exams (FRCPath) for everyone who wants to be consultant pathologist (i.e. the top job).
Therefore if Molly was a fully qualified pathologist she should be address as Dr. Hooper. To give her full qualifications she should be Dr. Hooper MBBS, MRCP, FRCPath
However she is referred to as Miss Molly Hooper. There are three ways one can interpret this:
- Molly didn’t bother to correct it. Doctors find it rather hard to say “actually, it’s Dr Hooper”. It makes you sound awfully arrogant.
- Molly doesn’t actually have a medical degree - this would make her more likely to be morgue technician.
- Molly is a surgeon with a full medical degree and a Membership of the Royal College of Surgeons. For traditional reasons, Molly is entitled (and usually required) to drop the doctor from her title and revert to Miss. What on earth she’s doing wearing in white coat and wandering around a morgue will be explored later.
Possibility 1 - Molly’s actually a real pathologist
This is probably much more likely than the other scenarios because she certainly spends a lot of time looking like a pathologist.
There are four specialities within pathology:
- Chemical
- Histopathology
- Microbiology and Viral
- Haematology
If you’ve ever had a blood test or a biopsy: the pathologists are the people who actually do the tests and write the report that your doctor gets. They have very little patient contact, which suits some people, and spend nearly all their time working in a laboratory environment.
Side note - White Coat Syndrome
Technically patients in the UK can’t get white coat syndrome because their doctors do not wear white coats anymore and have not done for nearly ten years. White coats are not the most hygienic of clothing, given that they have long sleeves that can trail all over the patient. The NHS regulations now state all medical personnel who come in contact with patients must be “bare below the elbow”. Ties have also been banned in hospital because they can also pose an infection risk.
Nurses all have uniforms that signify their rank but doctors can wear whatever they like as long it looks professional. However I know one doctor who likes to wear colourful shorts in summer and his patients love it!
So fanfiction writers: please do not have John wandering around a hospital wearing a white coat. He should be in a shirt with the sleeves rolled up and not wearing a tie.
Going back to Molly - as a pathologist she will be wearing a lab coat because she works in a lab most of the time. She also appears to spend a lot of time in the morgue and knows who all the dead bodies are. Therefore it is more likely that she is a histopathologist because they end up doing the post-mortems as well as looking at specimens sent from live patients.
Histopathologists also do forensic post-mortems (which can explain why two murder victims were in Molly’s morgue in TBB). However the procedure for a forensic post-mortem is very stringent and requires special training. If you think Molly is a consultant pathologist (i.e. a senior doctor) she might be doing the hard post-mortem cases: the unexpected and suspicious deaths.
However the police force also employs fully qualified pathologists. In a big force like the Met, they would have their own resident pathologists (who are doctors) doing their forensic post-mortems. Police forces don’t usually have morgues, though, so this may be why they needed to store the bodies in Bart’s. Additionally at that point in TBB when we see the bodies - foul play had not been suspected and NHS pathologists do end up doing post-mortems for suicides.
Having said this, post-mortems do not take up all of Molly’s time. A large bulk of her work is actually preparing and examining specimens from both the dead and the living under a microscope. Biopsies and excisions from any organ in the body need to be reviewed and reported on by histopathologists.
Pathologists usually work very sociable hours. Their patients/specimens are not going anywhere - mostly because they are dead. However there are always pathologists on call because there are genuine emergencies when a result is needed immediately perhaps for the patient’s individual treatment or public health concerns. It is not far-fetched that Molly would be on call at Christmas. She does not need to actually stay in the hospital nor does she have to put her social life on hold. She just needs to turn up if there is an emergency sample to be processed. Therefore, I think she wouldn’t have really minded going into hospital again to show Sherlock Irene’s “corpse”. She was mentally prepared to go into hospital at a moment’s notice anyway.
Side Note - what Sherlock really did at Uni…
Given the types of experiments Sherlock tends to run - I often wonder if Sherlock actually did Natural Sciences at Cambridge instead of just Chemistry in another University (Natural sciences in Cambridge form is not offered anywhere else).
In Cambridge the Natural Sciences course contains modules from all branches of science: physics, chemistry, biology, geology, material science etc. The Natural Scientists (Natscis) all have to do Chemistry in their first year regardless of what other modules they choose. In their second and third years they get to choose just the bits they like. In my personal opinion (and given there is a head in the fridge) Sherlock specialised in pathology.
The pathology course at Cambridge is the same course that the medical students take. There are lots of lab practicals, which teach students how to stain for bacteria, test for toxins, culture bacteria/viruses and examine post-mortem slides and gross anatomy. No practicals that involve microwaving eyeballs or saliva coagulation, though.
Sherlock uses all these skills in his work as a detective. For example: he manages to identify C. botulium on Carl Power’s shoelaces.
(By the way, that image we get shown is not actually of Clostridium botulium. It is also an electronic microscopy picture that you have to use a huge machine to generate. Under a light microscope: C.botulium spores have to be stained before you can see them. However it is not far-fetched that the spore can still be on the laces after all these years. Bacillus anthracis causes outbreaks decades after the initial outbreak)
This is what Clostridia actually look like stained properly under a light microscope (they are the blue rods with white heads).
For a more detailed exploration of Sherlock's university life please read: Oxbridge - Camford? Sherlock's University Life.
Possibility 2 - Molly’s a morgue technician
Pathology labs and by extension the morgue employs lots of technicians. They generally keep the equipment in order and file away specimens if need be (this actually includes corpses). In haematology labs they may run samples of blood test for the doctors and perhaps fill in routine paper work.
Otherwise they don’t make any of the decisions about what happens to specimens/corpses, nor do they do any medical stuff such as post-mortems. However they do have the same unrestricted access to the lab/morgue where they work.
This is consistent with what we see Molly doing during the TV series but this explanation is a bit boring.
Possibility 3 - Miss Molly Hooper, the surgeon
This is personally my favourite interpretation - I’m all for women in surgery because there’s current not enough!
If Molly is rightfully addressed as Miss Hooper, she would have already passed her Membership of the Royal College of Surgeons (MRCS). This exam allows her to progress into a surgical speciality training program. We have no clues as to what kind of surgery Molly might have chosen to specialise in but we can deduce something from the fact she is spending a lot of time looking like a pathologist.
Getting a consultant post in surgery is very hard - many surgical trainees who want a post in big teaching hospitals like Bart’s take time out to do either a PhD or an MD. They are both research degrees but an MD takes less time than a PhD.
In order for the extra degree to count in a job interview, you need to do something related to your surgical speciality. Orthopaedic surgeons like to investigate how bones heal, for example.
Molly is wandering around the morgue in a lab coat because she's doing a research project in the pathology department as part of her surgical training.
The fact that Molly is doing a (most likely) histopathology project can suggest anything. However she does spend a lot of time in the morgue, although we never see her doing a post-mortem. I personally think that Molly is doing a research project into surgical mortality.
The surgical specialities with the highest immediate mortality rates are: colo-rectal surgery, cardiac surgery and heptobilliary surgery. These usually involve very large operations that require anastomoses (joining up) of bowel or blood vessels. Patients can die on the table due to blood loss/shock or immediately afterwards due to short term complications like infection, anastomosis failure, blood loss etc.
If you want to imagine Molly doing lost of post-mortems in the morgue, her project may be investigating the causes of anastomosis failure in patients who have died in hospital. She may be training to be an, upper GI, colo-rectal, hepatic or heptobiliary surgeon.
Most surgeons doing a PhD also do on call rotas at the hospital they are working. This may explain why Molly appears to be in the hospital any time of the day or night. She’s not actually doing her project but helping out with emergency cases.
This puts a whole new slant on Molly’s character. Being a woman in surgery is difficult because it is still a male dominated profession. It is also extremely hard work. I personally think Molly is an very strong character despite her reactions to Sherlock. Sherlock is not a patient or a colleague, he is her unrequited love interest. Just because Molly occasionally goes a bit soppy over Sherlock and lets him walk all over her doesn’t mean she isn’t capable of making tough decisions or leading a team of doctors.
Faking Sherlock's Death
Good news to all those fanfic writers out there: Molly could totally forge Sherlock's death certificate (as long as she's a doctor).
Any qualified doctor is allowed to write a death certificate. Usually in the middle of the night, it's the most junior doctors who get the grisly task of pronouncing someone dead and then filling out the form. If they can do it, everyone more senior is able to as well regardless of what speciality they are in.
If a body is bought straight into the morgue off the street, it will be the pathologist-on-call's duty to certify death. If Molly is a pathologist she can easily arrange to be on call during Sherlock's suicide attempt. If Molly is a surgeon doing a research project she may still be able to do this.
Doctors doing PhDs "moonlight" as a great number of things for money. PhD funding is about minimum wage and doctors are used to living on much bigger pay cheques. Being on the pathology on call rota is actually a much easier (if less well paid) way to spend your time. Pathologists do not have to be in the hospital during evening and weekends if they are on call, unless an emergency happens. Surgeons below the level of Consultant must stay in the hospital because they will be the person responsible for all the surgical patients in many different wards.
The pathology department could be practically begging Molly to do some on calls to take the pressure off everyone else. This might have been very attractive to Molly as you don't actually have do every much as an on call pathologist. There are very few occasions when you have to examine a specimen right now. All you have to do is prioritize the list of jobs received over the on call period for the person coming into work the next morning.
The Non-existent Post Mortem
Many fanfic writers have been quite caught up in how Molly is going to fake Sherlock's post-mortem.
The answer is: she doesn't have to.
Post-mortems are usually only carried out in the cases of unexpected death, suspicious deaths or undetermined cause of death.
There are two distinct types of autopsy:
- Medico-legal/forensic autopsy - carried out at the express request of a Coroner in order to ascertain facts that will have bearing on a police investigation or legal case. For suicides, these are really only carried out if there is suspicion of foul play by the police. Non-suspicious cases fall under the second category of autopsy
- Clinical autopsy - perform only with written consent from the patients family to determine the pathological sequence leading to death. This is usually only done for unexpected deaths. Open and closed suicides are a very sensitive topic and pathologists usually do not offer an autopsy to the family.
Therefore as long as Mycroft does not demand an autopsy and the police decide the carnage at Bart's was a double suicide, there is no need for Molly to even produce a post-mortem report.
If Mycroft is in on the whole thing, Molly might not even need to produce a body. A simply death certificate filed correctly will be more than enough.
Other Parts in the Series:
Part 1 - Exploring Dr Watson's Army Career
Part 2 - How can an Army GP be fighting on the front lines? John's Dual Career
Part II.I - Dr Watson: scientist and psychiatrist
Part 3 - Guide to making John a Realistic Army Surgeon