What I should probably tell medical interns but almost never do

Media coverage of the long working hours of junior doctors has caused much discussion and argument among my peers. Articles such as this (where a journalist follows an intern on call) and this (where an intern claims her hours are illegal) have generated responses ranging from anger to sympathy. We know that internship is difficult, but it is something that all of us more senior doctors survived. Granted, we lost some colleagues along the way, but for the most part we believe perseverance is worthwhile. Maybe, though, we never take enough time to talk to interns about their experiences, and to help them through it. In the chaos, perhaps we forget that we are not just supervisors, but mentors too.

What would I tell medical interns if they asked me if this job is worth it? This:

I feel for you because yes, being a doctor can be horrible. Regardless of the salary or of how many have done it before you, there are few things as awful as the furry-toothed, sweat-soaked, hyper-emotional state achieved when you’ve been awake for 30 hours, dealing with complex problems and demanding people the entire time. It’s terrible that you can be on your feet for more than three times as long as a “normal” person and still feel like a failure at the end of it, because of one little mistake you made during the shift. It’s awful to leave your family tucked in bed while you head to work on a Saturday, to repeatedly miss out on parties and weddings and long weekends away.

I know the frustration you feel when faced with blank looks from nursing staff that don’t seem to know the first thing about anything medical. I know the hatred you feel for registrars who make you do yet another blood test on a patient you’ve just finished torturing with a needle. I know how thankless patients are, the disgust you may harbour for drunk patients who spit and vomit on you while you’re trying to help, the anger you may feel towards people who allow their disease to fester until they’re unsalvageable. I know the shame you feel when you turn your back on a six-hour long queue of needy people because you need to pee, and how unfair it is that you should feel that shame, because you’re doing your best. I know the 3am darkness, when you feel that you absolutely just cannot continue, and yet you must because there’s an infinite pile of work still to do.

It gets worse.

The hours you will be expected to work will increase. Interns are now fairly protected, and hospitals face losing their accreditation to train interns if they force them to work too many hours. That protection vanishes not only when you leave internship, but also when you enter the private sector, where nobody regulates hours. Those rushing to leave the state should speak to private practitioners about how many hours a week they work and how many weekends they spend with their children. Their answers may displease you.

The possibility of failure and the consequences thereof, become more significant. In order to perform what is required of them, interns need to do little more than work through a list of tasks set at the start of each day. Good interns will go above and beyond this, but you never have to make a decision that will decide between life or death for a patient. In talks with the press, interns claim they’re often unsupervised. This is untrue: there is always someone to ask for help at accredited facilities, even if you are scared or reluctant to do so.

But it gets better too. Satisfaction increases. Never making big decisions means never reaping the rewards of good ones: the pleasures of cure and of suffering relieved. Although mastering the small skills required of an intern is gratifying, it’s not on the same scale as becoming an expert within a field.

The menial tasks that make your job hateful get outsourced to new interns as you move up the ladder. You can eventually (mostly) avoid the parts of medicine you dislike: operating for some, listening to the rantings of delusional psychiatric patients for others. Eventually you will understand the ranks of the nursing staff, and learn to get the best out of them.

You will be thanked. Not every day, and perhaps not by those who owe you the most. But here and there will be someone who is grateful to you for something silly, like bandaging a tiny wound. A kid who one day was crying and terrified might high-five you the next. Now and then a family member will shake your hand and thank you for your efforts — sometimes even if the person you were caring for died. These platitudes will be few and far between, but they will hold a special place in your heart.

I know that the system, which seems to value nothing more than your ability to stay awake and see patient after patient, is not capitalising on the talents that got you into medical school. There’s no time to apply your bright mind to interesting problems, you have no more reserves for compassion. Possibly, these conditions are robbing you of the chance to be the doctor you could have been, had things been different. The thing is, this is South Africa, the setting is what it is, and the job is what it is. There are too many sick people and not enough doctors. People become ill at inconvenient hours. We are living in a TB and HIV epidemic. None of these problems can be solved by the minister of health overnight, and none are unique to this country.

Imperfect systems should be challenged, and I’m proud of my young colleagues for doing so. But regardless of where it is practiced — in the state or in private, in Africa or abroad — medicine is a demanding career. The hours will always be long. The road will always be hard. And those truths must be faced if you wish to continue this journey. Most of us still in the profession believe the journey has been worthwhile for us, but that may not be true for you. Only you can decide.

Image – Gallo