Anyone read The Intern Blues?

[sunflower79]

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Hi SDNers,

I just picked up The Intern Blues and couldn't put it down. But I am concerned about the stress and the deterioration of personal life that occurs to the interns. Do their stories still hold? Is such a stressful life unique to interns rather than residents? If I go into general IM or subspecialize (cards, GI etc) would I be subjected to the one-year hell?

cheers,
sunflower79

 

[mws99]

Yeah I just finished reading that too. I don't think it will be as bad for us. We will be working under the new 80 hour limit so that will be better. Also, they were working in the bronx, I don't think there are many places in the country tougher to work in than there. The biggest thing that worried me was the Afterword, none of them seemed too thrilled about being doctors.

 

[Silvertip]

Excellent book. You probably shouldn't read it if you are apprehensive about intership, but I thought it was great! Couldn't put it down. As far as the afterword goes- remember that the internship year portrayed in the book was a peds internship rather than a transitional year or other. If one was less than enthusiastic about peds, this intern year would have been horrible. Also, as it was an urban peds internship, there may have been a lot more abuse and other stressful and negative experiences that one might not find as much as suburban community hospitals. The female physician ended up not even practicing medicine- which may have happened if she had done any other type of internship as well. I think peds is one of those specialties that takes a special person, a tremendous amount of patience, and a lot of drive. Best of luck to anyone who wants peds. I couldn't do it.

 

[Kritenoel]

I own the "new" version and like the additional stuff that was added. I got a lot out of this book - I know things have changed in the "intern" system, but I think my clinical years are going to include experiences like the ones mentioned in the book. They really hit home how long the days/nights on call can be, and how awful the every three day call is! (someone pass this book to people who think being a doctor is all "fun stuff...")

I reccomend it as a must read for anyone who wants to go into medicine!

 

[MaybeMD]

^I finished that book this past summer. It's great! The only problem with it is that these people did their internship a long time ago so I don't know how it is compared to today. They should make an "Intern Blues 2" or something with brand new interns.

 

[Adcadet]

I read Robert Marrion's Rotations, which I believe is a follow-up to Intern Blues. I read it a while ago and got the impression that the internship year is pretty damn difficult. I spent a good deal of time working (see patients) alongside IM and FP resident at a county medical center this past couple of month. I was always amazed at how calm and relaxed they seemed. They admitted that they did have a ton of work to do, but it did seem that they got sleep, went home at night, and went out on dates and all.

 

[tristan]

I read the book about 2 months ago. I don't remember any details, the impression I had (of being a doctor) after reading the book was somewhat negative. But after thinking about it, the book seemed negative because the authors complained all the time. They wrote "I hate this hospital" "I hate this rotation" one too many times.

Overall, I thought the book was informative. But we have to remember that the stories are from a person's point of view. An author with a more positive attitude could see the situations and circumstances very differently.

Just my $0.02.

 

[DrLady]

I read this book a year ago, dec. 2001. I thought it was a great book, i could hardly put it down!!! haha..when I saw ER after reading this book, I was quite thrilled to learn that I knew some of the terms (which were confusing to me) what the docs on the show were saying, because of this book. I also read Rotations and I agree with Adacadet that it was more like a follow-up to Intern Blues. In this book, it showed the interns working under 80-hr/week. Robert Marion's other books, " The boy who felt no pain" and " Learning to Play God' are pretty great as well!!! I recommend to those who haven't read them.

 

[KyGrlDr2B]

I thought this book was horrible. In fact, I'm stuck at a position about 3/4 of the way through the book. It's the exact same crap over and over again! I also read Learning to Play God and I think that one is much better. I think the interns in The Intern Blues are so negative because they are right in the middle of the toughest part. You know how much you complain when something crappy is going on and then once it's over, you say, oh I can't believe I reacted so horribly? Well, I think (or hope anyway) that they hate everything just because of the conditions they are practicing in. I would hope that they could look back on things many years later and say, yeah it was bad, but it was worth it, etc.

 

[optimistique]

I read Intern Blues. As a pre-med I was concerned about rigors of internship. I would recomend A Woman in Residence. I found it to be very empowering. Its about a single mother in OB/GYN residence.

Have you been to the website www.scutwork.com? I read some the reviews for my intended residency, Internal Medicine. Reading about their schedules seems to give a more objective view.

 

[vixenell]

I definately read it in one sitting... I couldn't put it down, either. It was definately one of my favorite of its kind.

 

[ModerateMouse]

I just finished the 2001 edition of 'The Intern Blues', and didn't want to create a redundant thread.

Overall, this book left a very negative view of what it's like to be a resident in my mind.

In the beginning, the interns actually cared about their patients, but very soon they started saying things like:

"OH NO! Why did Billy decide to crump [deteriorate] and ruin my night? Now I have to do more G*& damn work!"

I would expect a caring doctor to say something like:

"Oh, no! Why is Billy getting worse? It must be very frightening for him to be getting so much sicker. I hope I can help him get better"

It just seemed like residency training turned normal human beings into egotistic and extremely self centered people who were only concerned with their own rest and well being. Who cares that this 8 year old kid is dying? I sure don't.

I want to blame the interns, but a much more likely reason is the bad working conditions. Realistically, how can anyone be expected to care for their patients when they haven't slept in 30 hours? I probably wouldn't be able to.

The 3 residents whose stories are in this book also seemed to have very few positive experiences. Isn't medicine supposed to be a mix of good endings and bad endings? Or did these particular residents just happen to be whiny brats who ignored all the happy stories?

The bottom line is that this book is very discouraging to read. It makes it seem as if internship/residency is a long and soul sucking process.

Granted, there apparently have been some changes to the work rules. But, have they really changed the underlying spirit of the training? I don't know.

So what do people think? Has medical training really changed? Does anyone have specific examples (good or bad) from the 2000's?

... the impression I had (of being a doctor) after reading the book was somewhat negative. ...

Yes. Agreed.

But we have to remember that the stories are from a person's point of view. An author with a more positive attitude could see the situations and circumstances very differently.

Actually, the stories are from 3 different interns' points of view. And all these points of view agree that 'internship was one of the worst experiences of my life.'

 

[Daedra22]

I found the book very compelling; if you want a more modern account of intern year, you might also enjoy "Intern" by Sandeep Jauhar. While I didn't feel like his perspective was quite as harsh as those exhibited in "Intern Blues," it still showcases how hostile medical education can be. I would recommend it.

 

[naus]

We'll be on a 60 hr work week as interns.

Evidence based medicine has proven that 100-120 hours a week != better care. In fact the outcomes are the same with lower hours, but the latter is far more humane.

 

[caelum7]

unfortunately you'll be working a more than 60 hour weeks as interns. we already have night float systems in place and our ward interns are working 60-75 hours average.

however, it's totally doable. since most programs are front-loaded currently, the new acgme hours will shift workload to the pgy2s, there will be a lot more overnight call and night float during later residency years. spreads the pain i guess.

 

[drizzt3117]

Most residents I've talked to feel that the new work hour restrictions will hurt learning. Maybe that feel that way bc they've already been through it, but it seems like a potentially valid concern.

 

[The Angriest Bird]

Well, I'm an intern right now. General Surgery.

I'm very fortunate to be in a very benign program. We are totally compliant with the 80-hr rule, and 98% of the people around us (attending, seniors, nurses) are nice, normal people.

There's little doubt that intern year is THE WORST along your medical career. In fact, my pre-med years are probably worse because I was working like a dog to defend high GPA while studying the crap out of myself for the MCAT.

For the most part, it's about who you are. The intern is always the "path of least resistance" for any BS, stress, and mishaps. Anybody can give you ****. You can give nobody ****. That really sucks. It happens on a daily basis that I see senior residents making the exact same mistakes as I do but never hear anything about it.

Despite the fact that interns are technically higher than medical students on the totem pole, they are practically inferior. A program cannot stress too much out of medical students, because 1) they sometimes don't care 2) very few med students do poorly enough to actually fail; even if they do fail, they can challenge and revert it. A "C" on your surgery rotation has little effect on your career unless you want to do surgery 3) they do have weapons against the residency programs; a medical student on fire is pretty tough to deal with.

The classic adage is "they can hurt you, but they can't stop the clock". It's 12 months, 365 days, 8760 hours. The new ACGME requirement for next year will greatly decrease intern stress, because the 30-hr call really really blows. Not to mention the banning of home calls.

 

[KeyzerSoze]

We'll be on a 60 hr work week as interns.

Where's that?

 

[Seven of Nine]

It just seemed like residency training turned normal human beings into egotistic and extremely self centered people who were only concerned with their own rest and well being. Who cares that this 8 year old kid is dying? I sure don't.

not that i've been through internship/residency myself, but in lending an ear to friends going through it right now, it seems this shift in attitude could be, in part, attributed to self-preservation. in some rotations/fields, you can face a constant barrage of critically(and terminally) ill patients, and it may seem like your efforts and treatment aren't doing much (or anything) to improve the patients' conditions or alleviate their pain. you become desensitized or try to maintain distance from patients just to survive the shift. not being able to save that kid would be pretty devastating to everyone involved, especially if it isn't the first time it happened.

 

[caelum7]

Most residents I've talked to feel that the new work hour restrictions will hurt learning. Maybe that feel that way bc they've already been through it, but it seems like a potentially valid concern.

i don't think it will be a big deal. you will perhaps need a little more motivation to go back and look up patients you admitted on night float to see what you could have done better/differently. you will get really good at signing out to each other, but you will also have perhaps more regular time to read. your workweeks will seem like they drag on because you won't see daylight for 6 days at a time, but you will be well-rested each morning.

re: changing personality- honestly i think the same types of personalities that started med school are the ones that finish residency. the same guy who blew off class and was adept only at dodging clerkship work will be the same in residency. on some level you lose your sense of urgency with every sick patient and you develop a sense of humor about some situations, because you get comfortable with them and you develop ways to deal with burnout and frustration.

both ends of the spectrum- the super earnest, humorless, ever-concerned hero and the crass selfish lazy misanthrope will be equally annoying to fellow residents.