Hierarchy in hospitals
In a Hospital Hierarchy, Speaking Up Is Hard to Do.
當醫學生和實習醫師的時候，如果發生和主治醫師或住院醫師意見相左的時候，多半都不太敢主動提出自己的想法，一方面怕自己書念得不夠，犯了愚蠢的錯誤，就算自己有九成的把握，也擔心讓hieracrchy的上層難堪。而選擇噤聲的結果，很可能違背了醫者的使命，使病人權益受損。
就像文中的這一段：
Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Yet even though such acts can jeopardize patients, the inclination and ability of young doctors to speak up is hampered by the hierarchies in teaching hospitals.
文末提到目前的feedback措施（由醫學生針對他們的住院醫師及指導主治醫師來評分）正是針對這樣的制度而設計，但只要Hierarchy下在高位者不願意放棄自己高高在上的自尊，這樣的制度很可能被解讀為一種告密、揭弊的行為，而非本來促使教學相長的原意。
