Interview with Sandeep Jauhar, MD, Author of "Intern"
The New Book, Intern: A Doctor's Initiation Tells All
Dr. Sandeep Jauhar's powerful new book tells his story—how a young Ph.D. student in physics decides to change course and go into medicine to help people—and what the wrenching intern and residency process did to him along the way. For reviews, a blog, and more information on the book, see www.sandeepjauhar.com.
Interview with the Author: Sandeep Jauhar, MD
Q: What were your goals in writing this book, for both doctors, and for the public?
A: Internship is a really tumultuous time in a doctor's life—it's a time of firsts, you preside over your first patient death, have your first on-call night—it's a memorable year, and I wanted to record a history of internship for myself, and for future doctors. Med students often think of their attending physicians as infallible; and then internship and residency are a rude awakening, because attendings are not always knowledgeable or up to date.
There's always a risk that lay people will be afraid of going to the hospital, or going to a doctor, but obviously that's not the goal of the book. The goal is to empower patients and lay people to understand how hospitals really work, how doctors really think, and to spur them to advocate for themselves, ask questions and demand more information.
Q: The New York Times described you as "an unpromising candidate" for the field of medicine. How did you feel about that characterization?
A: I was taken aback when I read that! Doctors are not a homogeneous group—we're not all Type A personalities—that is, in fact, a shrinking minority. Doctors are like everyone else—we have doubts, ambivalences, second careers, third careers; we're prone to depression, and increasingly, as a group, interested in living a life outside the hospital. I think the larger point of that review was, look where this guy started from, and look where he ended up. My example will attest to the possibility that you can start off ambivalent, and end up very happily fulfilled in this profession, it can accommodate many different personalities. The great thing about medicine is that nothing is set in stone—you can start in Surgery and switch to Internal Medicine, you can find your path.
Q: How do you feel about residents' long work hours? Despite the grueling hours, you seem to endorse it in the end as a way of training excellent physicians.
A: That's a complex subject. It's very clear that a professional cannot function on little or no sleep, that's really a no-brainer. I think that the general trend towards getting residents out of the hospital post-call and not requiring them to work a half or a full day post-call is a good thing. But the issue that comes up is the unintended consequences of any reform you put in place. I work with interns who bemoan the fact that they are forced out of the hospital and can't attend to a patient who's crashing, or attend a teaching conference.
With frequent patient handoffs, there will always be a risk that not all the information will be imparted. We must have a standardized, computerized system for hand-offs, as a national goal.
I think in the future, we may have to create a system that respects individual learning styles, and individual work styles. Some residents can elect to have a longer residency overall with shorter work hours, while others may prefer a more intense residency that they can barrel through. The key is appropriate supervision and a safe training environment for everyone.