Customer Reviews

Rotations: The 12 Months of Intern Life

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Having read Learning to Play God (excellent) and Intern Blues (very elightening), both by Dr. Marion, I was thrilled to find Rotations on the shelf of my local bookstore. His desire to convey how much and how little has changed since the mid 80s when Intern Blues took place is commendable. However, his effort was fair to middling at best (if you have read the previous two books). Women are more accepted (thank goodness) and family leave time for pregancy is no longer much of an issue. But, late nights, incompetent techs, and 9-5 nurses (and doctors!) still exist basically unchanged. The main problem that I had with this book was the paucity of NEW information. Refering to previous works (Intern by Doctor X is very educational) can add to a work, but I felt that Rotations relied to heavily upon them. Dr. Marion is an excellent and honest writer, but Rotations is not the first of his works that I would recommend to my friends.

The author spends a majority of the book reliving his own experience as an intern, there is plenty of items reprinted from the "Intern Blues", and only a small portion devoted to the three interns whom the book was supposed to portray. If you've read "Intern Blues", don't bother with "Rotations", just read "Intern Blues" again. These two books are almost identical.

I like Marion's idea of using actual intern diaries to describe residency life -- is there a better way to hear it than "directly from the horse's mouth?" However, Marion chooses to use not only the three diaries from his most recent interns (the 1994 class), but also includes many diary enteries from his "Internal Blues" residents. His constant switching from current to past diaries made reading the novel confusing -- I often found myself paging back to the prologue to try and determine who was who. And to add to this already perplexing situation, Marion frequently chooses to add tidbits from his own intern experience.

In addition to the fact that the large cast of characters made the novel confusing, the book was also lacking a "big picture." A collection of little stories pieced together, the author allows us brief glimpses at moments of the intern's lives, but there is definitely a lack of continuum and focus. Taking the juiciest, most interesting enteries from the intern diaries keeps the reader awake, but the lack of continuity often caused my mind to drift elsewhere. And by the time I was back to being focused on the story, I had to read the prologue again to figure out who the character was.

One "benefit" of this book: Marion includes much of what was in his "Internal Blues" book in this novel. So if you are into making bargain buys, this is a "two-for-one" deal.

Rotations: The 12 Months of Intern Life

The 'Prologue' says since "managed care" came, life for medical specialists and their patients has become increasingly complicated. Specialists can't schedule tests for patients without first calling the patient's primary care provider to explain why the tests are medically necessary. Then the specialist has to explain to those doing the tests just what the concern in. The primary care provider must authorize a second visit to discuss the results. All the time spent in making phone calls, discussing or arguing about the need for the tests, reduces the number of patients seen during a week or the time spent in evaluation. Does this system benefit the patient of the HMO's stockholders? It makes providing excellent care to patients more difficult.

This change in American medical education is to focus on the training of family practitioners, generalists, internists, and pediatricians; subspecialty care is less of a priority. Along with this, in New York City there were mergers between medical schools and teaching hospitals to create monopolies in the delivery of care, and the ruin of many smaller facilities. The Federal government pressured a decrease on residency training programs and the number of doctors by as much as a third in one example. Each of the twelve chapters tell of events for interns during the July to June year.

After a year, the interns are now residents. The 'Epilogue' sums up the effects of this stressful year. Dr. Marion gives his analysis of the Bell Commission and the effects of this law in practice. He has some recommendations for reform. Chapter 6 tells how and why "internship" was invented at Johns Hopkins Hospital in the 1890s to meet a financial crisis. Later it was called an "educational necessity. [There is no mention of how this is done in Scotland, England, or on the Continent. What are the comparative results?]

As a medical student myself, I have much curiosity about what lies ahead in the next few years of my life. The book ROTATIONS is about first year residents in the pediactrics field and the range of emotions and experiences they have. Overall, I was sorely disappointed in the book. There were some interesting parts in the book and the stories the residents told were both scary and intriguing. If the autor would have stuck with telling more stories and let them flow, it would have been a much better book. I felt that the author put very little work into the writing of this book, taking excerpts from his former book and books like HOUSE OF GOD by Samuel Shem, MD. There was, it seemed, little new material in this book and far too many reiterations of older books chopped together. I recommend to save your money and purchase another book about the life of a resident.

In "Rotations", physician Robert Marion seeks to add another tome to a rich succession of popular press works that document the bald facts about medical training. Armed with his own experiences and the audio dairies of several pediatric residents he explores the internship-the first year after medical school.

This approach, as the reader will immediately discover, is far from original. Marion acknowledges and liberally borrows from prior authors starting with "Intern", an anonymously written piece that appeared in the 1960s. He also extracts reams of material from "House of God", a 1970s cult classic by Samuel Shem, and his own "Intern Blues" that appeared in the 1980s. Against this backdrop he assimilates new material obtained from residents who trained in the 1990s.

The apparent objective of "Rotations" was to compare the experiences of these latest residents with prior generations of physicians who suffered through grueling post-graduate training. Marion focuses at length on the goals and practical outcomes of the Bell Commission, a body in New York state which attempted to reform residency training in the late 1980s. From the lives examined, it appears that only modest changes have occurred in recent decades: residents still work ridiculous hours, attend to endless scut and get abused to various degrees by hospital staffers.

Although the balance of the book is generally interesting and reads well, the reader is left wondering why "Rotations" was necessary. At times multiple pages are excerpted from the prior works and supplemented with little original material or interpretation. In the end, "Rotations" represents a "Cliff's Notes" version of earlier titles that might have been more satisfying to read in their entirety.

David A. Frenz

What's wrong with the system of training M.D.s endure for three years? According to Robert Marion, everything. Patching together the diaries of '90s interns with excerpts from books and his own memories, Marion leads us month by month throuhg a year of medical internship. Much about how interns suffer, how hateful and intractable the medical system is, rife with sarcasm. Apparently interns have enough energy to write diaries of their experience with stupid nurses, vengeful lab techs and God-complex MD-CEOs but not enough to appreciate the wonder of human biology and the extreme privilege of being allowed to get paid to practice for three years on onwitting patients before going on to the highest paid, most prestigious job you can have in the USA by just being good at a science and jumping through the hoops--one of which is internship.