Intern: A Doctor's Initiation by Sandeep Jauhar
My rating: 5 of 5 stars

I began the book with a groan “Oh no! Another cliched story of the overworked and randy intern going through his apprenticeship in the usual flippant manner.” However, it was a pleasant change in the narrative and this turns out to be an engrossing tale of self-discovery. Here is a cynical PhD in physics deciding to pursue a career in medicine. He is confused as he weighs his options to do law or journalism (in fact, he does an internship in TIME).

He describes the gut-wrenching details of his internship. He went through a dark phase of clinical depression and a painful herniated intervertebral disc.

He addresses the ethical challenges of practicing medicine. How does one balance reality with the four cardinal principles of Medical ethics?
• Respect for autonomy – the patient has the right to refuse or choose their treatment.
• Beneficence – a practitioner should act in the best interest of the patient.
• Non-maleficence – to not be the cause of harm.
• Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment.

These are interlinked with the concepts of “Primum non nocere” – above all do no harm and “informed consent”.

A senior doctor astutely observes “Autonomy trumps everything if the patient has capacity, but who decides? The doctor, of course. So ultimately the patient can decide only if the doctor says so. In the end, the power structure in medicine is such that only doctors can decide whether patients have the right to exert their autonomy. And how do doctors decide? It is based on their experience, their prejudgement, their prejudice; and some doctors have the prejudice that patients cannot make medical decisions for themselves. So in these cases, paternalism rules, and it’s a slippery slope toward a situation where autonomy is always undermined.

In contrast, there was another senior doctor whose statement could have been taken out of Catch-22, “We can get them (the patients) to do whatever we want. As long as they agree with us, they’re not crazy.”

Interestingly, the medical world in America appears to be liberally peppered with doctors of Indian origin.

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