Sunday, 28 April 2013

The truth about internship


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 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 suppose to do now that 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 doctor tweeps hits very close to home: 



It’s hard to believe that the first year where I’ve not been required to study all night could be the worst.. but it is! Internship is an impossible job to be brilliant 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.

By all measures, I was a great medical student. I knew the answers on ward rounds, helped my interns, 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 your surgeon regarding the appropriateness of pre-operative imaging. 
  • 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 is administratively efficient – something understandably but inconveniently not focussed on in 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 that most people don’t intentionally mean to bully the junior doctors – they are just unbelievably stressed and take this frustration out on those below them.

It’s interesting that all of our senior doctors have been through this and 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 blog 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...
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Saturday, 6 April 2013

Social Media and Junior Doctors


Once again my Facebook newsfeed is apparently full of strangers. It’s April, or the time when final year medical students change their surname on Facebook because they are beginning to apply for internships.

Despite a multitude of guidelines on social media and the medical profession, it’s still a topic most medical students approach with a fear cultivated by alarming medschool folklore. Let’s clarify a few facts about doctors and social media:


Fact: Changing your name on Facebook is not the solution


Before you call me out as a hypocrite – yes, I was guilty of this. I honestly believed that the ingenuity of using my mother’s maiden name instead of my own surname protected me from all the issues surrounding social media and job applications.

The truth is, medical workforce units aren’t idiots. If you post a public status that says ‘Health Service X are pretentious wankers’ – Health Service X can find that and when the profile picture looks surprisingly like the passport-sized photo you submitted – a tactical surname change isn’t going to be your saving grace.
Whilst hospitals don’t routinely search for you online, they do routinely search the name of their hospital. Every day I check my email by searching ‘Hospital X email’ in google. Given that google autosuggests that phrase on every hospital computer suggests I’m not the only one checking my emails this way. Wouldn’t it be awkward if your status was the result beneath the webmail link?

The lesson in this example isn’t to have a Facebook alias – it’s master the privacy settings. I find it terrifying how many medical students’ profiles I can view in entirety, despite not having them as friends. Changing all your settings to ‘friends only’ takes 5 minutes but is much more effective than a name change.


Fact: Medical Workforce Units do not have the time or the resources to check your online profile


Perhaps my favourite medschool folklore tale was that the hospitals had a magical computer program (not unlike the program for catching plagiarism) that finds all evidence of your online activity.

Much to my disappointment, my involvement in intern recruitment this year has revealed this program doesn’t exist. Furthermore, in 2012 over 1000 students applied to most Victorian health services. That is over 1000 CVs, 1000 cover letters and 2000 references to read– in just over 2 weeks. Some hospitals don’t even have the resources to interview candidates, let alone search for them on Facebook in the hope of coincidentally finding a status which puts them into the desirable or non-desirable intern pile.


Fact: Your employer realises you use Facebook


If my nanna uses Facebook, surely it’s safe to assume most people do. In fact, last week someone told me she didn’t have a Facebook and I found myself judging her and wondering what she was hiding.

The fact that you have a Facebook account has absolutely no implication on whether or not you will be a good intern.

Seriously. Again, I’d be more concerned that someone who didn’t have Facebook lacked the social skills to interact with patients.  


Fact: Your online profile exists, regardless of how careful you are


Even if you abstained from all social media, chances are there are still hits when your name is googled. I honestly find it a bit weird when the only hit on someone’s name is a 2005 Xavier College newsletter which mentions their efforts at the book fair. Have you actually done nothing notable in the past 8 years?

Given your online footprint inevitabley exists – why not make it a positive collection of things you are passionate about? If, as an employer, I DID google everyone, I’d be far more impressed to find a collection of interesting blog pieces on global health, or even a tumblr like this, than an awkwardly outdated newsletter clipping.


Fact: You shouldn’t be discussing patient details ANYWHERE


The bottom line of all the articles, guidelines and horror stories is that if you don’t break the rules you’ve known since day one of medical school, you won’t get into trouble:
  • NEVER discuss patient details with people not directly involved in the patients care
  • NEVER use identifiable patient details such as name, address or uniquities when using a case as a teaching example
  • Debriefing should ALWAYS occur in a monitored, safe environment - not in public.
  • NEVER badmouth your employer, anywhere, EVEN if you never intend to work for them again. It’s poor etiquette and makes you look disloyal to future employers.
  • If in doubt, don’t post it.

Fact: The benefits of twitter as a young doctor far outweigh the risks


I honestly can't recommend this more highly. There isn’t a value I could put on the mentors I have gained, the friendships made and the honest advice I’ve received through twitter.
Go into twitter realising it’s a public forum and that everyone can view what you say. Don’t deny you’re a doctor – why would you EVER do that? It’s an incredible privilege and means you have vast amounts of knowledge and innumerable experiences to contribute intelligently to any discussion on any topic. What a terrible waste it would be if the only positive difference we made was with the patients we see at the hospital – get involved in the community and use your education to enlighten and engage as many people as possible. 
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