This book, Trust me, I am a Junior doctor, by Max Pemberton – a medical practitioner and journalist, discusses about the life of a junior doctor, before they were re-branded as the contemporary ‘foundation year’ doctors, during his first year of practice in the NHS, after leaving medical school. It is compiled from his columns in The Daily Telegraph, focusing on his life as a junior doctor in the wards in a diary like account. Though quite pessimistic from the outset, it vividly narrates how the life of a junior doctor is somehow different from what prospective medics always dream of and greatly helps in creating awareness for those who want to make an informed career choice – including me. It tried to address how Max and his fellow fledgling doctors grapple with the complicated questions of life, love, mental health and how on earth to make time to do normal household activities.
What came as a surprise was the fact that junior doctors, who have already made an informed career choice and had done dissection, would all of a sudden look shaken in front of a dead body or fear to face the prospect of death – the crucial question of how to tell whether someone is dead or not. In the mind of a prospective medical school applicant, the view of Max Pemberton is right:
“Medicine is supposed to be upbeat: its aim is to save, improve, and extend life. This is what medical school focuses on and it’s why I became a doctor. I’ve been taught about the weirdest and most obscure medical conditions that affect only a handful of people, but death, that most universal of problems? Not a thing. In fact, I’m not even sure how to tell if someone is actually dead”.
His book put this fact when he picked one of their tasks – to certify patients dead – and talk about it with a fellow junior doctor as ‘never seen a body before except the cadavers at medical school’. In addition, to witness the worrying trend of a dream about work and considering work as a ‘waking nightmare’ leaves a vivid insight in the mind of the aspiring reader as to what being a junior doctor is really all about.
The writer used imagery techniques to describe what the normal task ‘ward rounds’ looks like in view of a new recruit: ‘trench warfare and it’s the junior doctor in the firing line’! The ward rounds are put here in the more practical yet humourous way – “The consultant asks a question, looking at the registrar, who then turns and looks at the senior housing officer (SHO), who then turns and looks at the junior doctor, who then looks at their shoes.” For most of us dreaming to be a medic, in theory at least, we share what junior doctors expected at the start: “Post-on-call ward rounds are supposed to be a team effort, with the registrar, the SHO and the junior doctor who have been on call the previous night supporting each other.” I enjoyed what is written under this topic as it gave me a clear account of the task divisions in a ward setting: The task of registrars is to do what operations are required as emergencies, whereas consultants come out if things are getting tricky. It is funny to understand all junior doctors worry about preparing patients to go to the theatre, order blood tests and chase x-rays, rewrite some drug charts and steering the notes trolley in a straight line on the ward rounds. I came to understand registrars even look scared during ward rounds as their clinical decisions would come under scrutiny. It is good to understand the fact that junior doctors, registrars and consultants will all be on call! What amazes me here is the unwritten rule that hospital doctors don’t take sick leave. It is the very reason that intrigued me much – “Taking sick leave is regarded as not being a team player, because it means that the registrar and SHO will have to do all the running around in lieu of the junior doctor.”
One of the most repeatedly raised issues denouncing the medical profession is working in an unsocial hours. He used the phrase ‘near apoplexy’ to describe the level of frustration the tight working hours brings about on junior doctors, and more often than not they spend more hours than is allocated and paid for because of the demanding nature of the work. Other fields of study are deemed to be better paid and the hours are not too bad, normal 9 to 5 jobs, when compared to what medicine entails. These facts summed up made him question the future landscape of his friendships. When the reader reads about Max’s experience about weekend calls, one can feel what Saturdays on call look like: ‘horrid places in hospitals’. He puts his frustrated junior doctors’ viewpoint – “You give up your weekend so that everyone else can go out and enjoy themselves and arrive in Accident and Emergency (A&E) to get stitched up when it spirals out of control.” We learn here how experience matters: the junior doctors consider the staff in A&E to be resilient as they have ‘seen it all, heard it all, and been through it all.’
Max used a lucid explanation to compare and contrast what medical schools used to teach and what exactly the working environment after graduation looks like by putting two clinical scenarios that put junior doctors in a dilemma for decision-making: Patient on a ward just gone into a kidney failure – not passing urine all night – which needs urgent attention, whereas patient on the other side got a high potassium level, which causes heart to stop and is hence an emergency too. According to his words, “Cool and calm medical school atmosphere taught us how to deal with emergencies and memorised the protocol. What is omitted here is ‘which emergencies are more of an emergency than others’.” But some of the events even came as a surprise to me, may be a bit of exaggeration, to think of junior doctors as medical practitioners who would struggle to prescribe a sleeping pill. He made me understand what things keep junior doctors keep going – the belief that once it’s been endured, there are days before the next one! He also talked about the society group which is very difficult to control in the doctor’s room in his book and, quite surprisingly his assessment reveals, ‘Of all patients I have to treat, it is children who are the worst. Not the children themselves but the parents.’
The writer also addressed the fact that surgeons’ infamous nature of being reactionary and rude is evident in hospital grounds. The fact that dying people are seen as a bit of embarrassment to doctors gives an indication to the level of perfection doctors aspire to achieve and are expected to achieve as well at workplace. It is a bit frightening to consider these facets of work as ‘failure in doctors’ jobs’ but embeds in our mentality the level of responsibility the profession entails. Max also went further to reveal the kind of hidden partnership between the ‘Big Pharma’ and certain medical practitioners where conflict of interest occurs, stressing the need on ‘scientific research’ over ‘promotion material’. He also opposed private practice within the NHS from the perspective that junior doctors object to working almost for free under the consultant, who profits individually as well as bringing revenue to the trust. The book also teaches the reader how doctors are supposed to remain morally neutral about the nature of the disease being treated instead of judging a book by its cover.
The book is immensely informative on the dark side of medicine, though a bit far from what a mature applicant with a decent experience before embarking on medical school would probably feel. It also shed light in me to think in place of the doctors who are tired of being tired about everything they hate in the setting, and I also learned about courses of action available for doctors when faced with sick patients: from surgery, medication, or wait and see to what level they will have a say as to how the trust is run being in the lower rung of the professional career ladder. The wait and see approach is a magnificent recuperation mechanism of the amazing art-of-work, the human body, to correct whatever is wrong, and made me recall one of Voltaire’s quote: “The art of medicine consists of amusing the patient while nature cures the disease.” I would say I found this book entertainingly engaging and descriptively informative of what working as a junior doctor under the previous scheme used to look like.
But there is a relief that we, who are under the new Modernising Medical Careers (MMC) scheme and the European Working Time Directives, will be subjected to reduced hours and on-call requirements as a junior doctor than was practised before. It appears MMC was designed to shorten the training period for doctors but ended up with more or less the same amount of years previous trainees used to take to train because of the limitation imposed by the EU time directive.