I’d like to say he won’t hurt you. But statistics show it’s possible.

Remember the beginning of Three Days of the Condor, when Robert Redford goes out for a sandwich, and returns to find that an assassin has moved systematically from room to room with a machine gun and murdered all his colleagues? That was pretty much the scene I found when I visited my old workplace yesterday.

I’d like to think there was more to morale than petty behaviour behind the scenes. And that whatever the atmosphere, patient care wasn’t affected. But that is plainly ridiculous. Now that I am a patient more than I am a doctor, I’d rather my doctor wasn’t grumpy even before I tell him about my knees.

The NHS is an intensely tribal organisation, where the various power groups live within a precarious ceasefire. Only a thin membrane of etiquette stands between normal working and bouts of senseless slaughter. Sometimes it only takes one small incident – like shooting an Arch Duke – to set things off.

Etiquette is an intensely important aspect of medical culture. It’s history goes back to the middle ages, where practitioners were divided into three ‘medical estates’ – barber surgeons, apothecaries or physicians. Barbers had the sharp instruments and physicians had the sharp suits. Apothecaries, as now, had the shops on the high street. The professional codes of practice we have inherited are derived from power sharing agreements worked out centuries ago.

The thrust of recent changes has been the ascendency of Management, at the expense of the older professions like medicine and nursing. Like a new religion, or political party, managers have yet to establish a proper code of etiquette. Like the dog in the park, they jump up at people and leave muddy prints. Their owner tells them, fifty times a day, not to jump up at people, they’re not supposed to. But it takes a long time before a dog gets a firmware upgrade.

It’s unbearably rude to write about the position of the medical profession in terms of power relationships. As I write, I almost have to change fonts to something spidery, to reflect the delicacy of the discussion. Should we say, at least, that managers and doctors have an ambivalent relationship? Not love / hate exactly. More fear /loathing to be honest. This probably just reflects a wider unease about elitism in British society. The NHS is locked in a post-war time warp where snobby types need to be cut down to size. The NHS tends to regard eminent persons as ‘toffs’. If you’re a decent sort of toff, you can be a ‘boffin’. But just because you can recite the periodic table, including the rare earth metals, don’t think you can start telling anyone what to do, let alone bring your bike in your office.

I suspect other skilled technicians like engineers and pilots are still treated this way in their industries, apart from finance and banking, where elitism is positively glorified. I’d love to say something like, ‘it doesn’t take much to keep people happy, it’s the little things that matter: just bring back the lady with the tea trolley; let’s renew the subscription to The Guardian’. But I fear its gone too far. Max von Sydow is still lurking in the building. In fact he’s just reloading. But whose side is he on now?