The Footnotes

HEALTHCARE & NURSING

The truth about medical internships

Medical interns are the bottom of the food chain but it does get better.

I’ve wanted to be a doctor for as long as I can remember.

Not only have I wanted it more than anything in the world, I’ve given everything I have to get to this point.

Until you experience it, it’s difficult to imagine the sheer amount of knowledge crammed into our young minds at medical school and the sacrifices required for that process. I’ve spent more Saturday nights with Talley & O’Connor (clinical textbook purveyors) than at parties, I’ve broken up with boyfriends who didn’t understand the hours and I couldn’t count the sleepless nights or cups of coffee if I tried. What got me through though, was knowing it would all be worth it when I graduated as a doctor.

So what am I supposed to do now I’m finally here? Now that I’m finally living my dream, only to discover that it’s not that great.

This recent message from one of my favourite senior doctors hits very close to home:

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It’s hard to believe that the first year I’ve not been required to study all night, every night could be the worst but it is.

An internship is an impossible job to be great at. Can you imagine how that feels to a Type A personality? This is the first time in our lives that many of us have not been good at what we do.

I couldn’t count the sleepless nights or cups of coffee if I tried.

By all measures I was a great medical student. I knew the answers on ward rounds, enthusiastically scrubbed into surgery and did well on exams. I am not, however, a great intern and I can’t see how I can become one. I am organised, early and care for my patients immensely but there are so many things that are impossible to master about this job. For example:

  • A great referral will not change the fact many inpatient units have no physical capacity to accept a patient. The fact that these referrals are rejected due to system strains do not change that fact you’ve failed a task set by your senior.
  • No amount of negotiation skills will change the mind of a radiology registrar with different beliefs to the surgeon you report to (and have to tell inform about a failed imaging request from said radiologist)
  • No amount of time or effort will change the fact that our hospitals are understaffed and overworked and it is with absolute horror I have realised no amount of overtime will allow me to be on top of paperwork.
  • A good intern isn’t necessarily clinically impressive but administratively efficient – something understandable but not focussed on during medical school
  • My skin will never be quite thick enough to deal with the bullying culture

I work for an amazing health service whose support far surpasses the stories I’ve heard from other hospitals. No amount of mentoring or support can change some thing we face. Interns are the bottom of the food chain in any profession but this is heightened by the inherent bullying culture in many, if not all, specialities we rotate through. I’ve spent hours thinking about this and I honestly believe most people don’t intentionally mean to bully junior doctors – they’re just unbelievably stressed and take this frustration out on those below them.

This is the first time in our lives that many of us have not been good at what we do.

It’s interesting that all of our senior doctors have been through this and yet the culture remains the same. Certainly none of my colleagues are counting down the days until they are powerful enough to make some intern’s life hell. At what point do you start caring more about your career and conveniences than nurturing and supporting the next generation? Or am I too naïve to assume that all consultants started out as altruistic, scared interns just like me?

Of course, I am an incredibly privileged person to be writing such a post. Don’t think for a second I’m not eternally grateful for the opportunities and support that have got me here or that I’ve forgotten how easily I might have been one of the thousands who missed out on a place at medical school. I truly adore spending time with my patients and love the idea that I’m helping to ease suffering in some way. Most of the time I do love my job and this IS still my dream, it’s just a little less magical than it was when I was a medical student.

 

The truth about medical internships
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