Trust Me: I'm a Junior Doctor – Max Pemberton

This somewhat fictionalised diary account of Pemberton’s first year of medical practice conveys a strong and clear picture of the unexpected aspects of being an intern, from struggling with crippling sleep deprivation and useless consultants to inserting IVs (a skill not taught to medical students) and certifying dead bodies. The impact of death is something Pemberton returns to, a topic that’s too often inadequately covered during medical school:

Because we never actually think about medicine not working and people dying, it comes as a bit of a shock when we’re faced with it... The subject of death isn’t just avoided at medical school, but on the wards too. Dying people are seen as a bit of an embarrassment to doctors –
they’re reminders that we’ve failed in our jobs, despite the fact that dying is an inevitable consequence of being alive. Because of this, doctors tend to avoid dying people like the plague... It’s a bit unfortunate that a profession that continually comes up against death hasn’t yet come to terms with it.

True, but rarely openly acknowledged.
There’s also an articulate rant about the hypocrisy of middle-class recreational drug users, incidental humour (like his reflection, after a failed attempt at a night out with colleagues, that “the only thing worse than missing an avant-garde all-female dance interpretation of -Coriolanus is, surely, not missing it”), and quite a lot of acclaim for the underappreciated role of nurses.
This last is certainly balanced by criticism and concern about nursing roles. He discusses at comparative length his concern about allowing nurses in hospitals to prescribe drugs without having gone to medical school – if the UK situation is anything like that in Australia, the drugs he refers to are standard doses of over-the-counter medications like aperients and paracetamol (acetaminophen, without codeine), and can’t be given more than once without medical review. He also talks about his decision not to sedate an elderly, demented woman despite the nurses’ strong requests that he shut her up so they could have a quiet night. For Pemberton this was a difficult decision because he felt pressure to prioritise helping out the nursing staff (both because they’d been helpful and supportive in the past, and for fear that this would change if he didn’t accommodate their wishes) over the perceived best interests of his patient. Unfortunately, what neither the author nor, apparently, the nursing staff articulated was the effect of hours of demented screaming on the other, often quite ill, patients.
There’s also a heavy sprinkling of reflection on how bureaucratic rules (like a four-hour Casualty wait policy), outsourcing services, and cost-cutting adversely affect staff and patients, including a brief but reasoned discussion about MRSA (and how it’s not the fault – or at least, not just the fault - of poor hand washing technique in NHS hospitals). Pemberton’s argument for how and why private insurance undermines the NHS (using a transportation analogy) is strong and compelling, though I am a little biased - I'm also an advocate for universal health care, which is why I don’t have private insurance and as a result pay the Medicare levy surplice. Back to the book – on outsourcing parking, Pemberton recalls that “I witnessed the unbelievable sight of a man who had just seen his wife die in A&E being threatened with having his car towed away because he didn’t have a [parking] ticket.”
But the strongest impression I came away from Trust Me with was exhaustion – from the hours (as Pemberton points out, changing the law on how many hours they can work has – as in the US – only means junior doctors don’t get paid for all the time they put in) to the lack of support and sheer weight of responsibility. His entry about his biggest medical mistake particularly stands out in this regard – Pemberton, distracted by being responsible for a patient following an unfamiliar but potentially serious procedure, missed a serious but not uncommon unrelated medical issue. The patient was fine, the registrar was unhappy about having been woken in the middle of the night, and Pemberton was distraught, but all was fine. Of course, what lingered was both the knowledge of how differently it could have ended, and the fact that it was all around the hospital by the next day. I was tempted to reach through the book and tell him that there’ll be bigger mistakes coming down the track.Less funny and painful than the classic tale of a medical graduates’ first year of practice (the immortal House of God”), Trust Me is also more honest, more political, more reflective and more true (and thirty years newer). - Alex