Prognosis Poor: A Review

I was sitting at the Greyhound station last week, waiting for my bus to board so I could go spend a week with my sisters and mother over the Christmas holiday.  Dr. D was working a 24 hour in-house call shift Christmas day and wasn't going with me.  So far, odd years of our four year residency mean we celebrate Christmas apart.  Welcome to year three. 

I was really excited to see Frances Southwick's Prognosis Poor:  One Doctor's Personal Account of the Beauty and Perils of Modern Medical Training.  As she mentions in the  Physician Family ​article that alerted me to the book's existence, there is a section (actually one of the appendices) titled "How Jude and I Stayed Together."

I immediately (thanks to Greyhound's free wifi) purchased and downloaded the slim volume and started reading. South wick's personal reflection is far more handbook than personal journey; she sets out with a lofty goal--to create a new The House of God for the 21st century.  While the book does give us a first person account of Southwick's depression and her grueling schedule, don't expect it to read like a novelization of her experience.  Here are the strengths of the book which make it one that I will definitely continue to recommend to all entering residency (either as the resident or the significant other):

• The book does a reasonable job at discussing the Match and the preceding application and interview process. To most non-medical folk, the Match is pretty mysterious.  The analogy to being stationed somewhere as if you're in the military is a good one.  
• The detailing of Dr. Southwick's schedule would be eye-opening for soon-to-be residents and their families.  In discussion groups I am in, the familiar complaint is "how do I get family members to understand that my Dr. Spouse is never home and when they are they still aren't here?" which roughly translates to "How do I get that tangential family member to not be pissed because we can't make their third baby shower?" You could just start handing out copies of this book on those occasions to family members.  Oh, and read it yourself when you're complaining about scrubs being on the floor or the fact that you're the only one who scoops the cat box and takes out the trash.
• I think we all probably face moments in our work life where we worry that people will discover we're truly incompetent.  Dr. Southwick shares those moments and helps non-residents see how the grueling schedule of month long rotations through services that are not within the resident's specialty take a toll.
• Dr. Southwick is very frank about her struggle with depression and anxiety in her three-year residency in family medicine. This was perhaps the most important part of the book for me, as it led to some discussions at home about depression. I literally asked Dr. D:  "You haven't scoped out available bridges for which one would be best to leap from?"  Thankfully, she hasn't. She has joked on occasion during a less than lovely rotation that maybe she could fall and break a limb so she could have a day off, though.
• The book made me glad that we started this journey of residency in our 40s, not our 20s.

As a quick read and general tips book, this is well done.  The chapters are aptly titled and they are short, which any new resident will appreciate.  The book does have some limitations:

• The list at the end (the appendix) about how she and Jude stayed together is basically a listicle with tips.  While these are good tips, they are almost an after-thought.  This perhaps is a good (if depressing) thing; I found myself cringing a bit a few times reading about the relationship and upon reflection realized that here's what I know about the couple:  They spent roughly 16 minutes a day interacting (awake) with a two hour scheduled date once a week.  There is one scene where we find Jude (the partner) crying and wandering about the house which ends with the two of them crying in the living room floor.  While this is a frank sharing of a moment they had, the book is filled with bleak moments that are not well-developed.
• The book is very individualized; while some of the experiences translate, realize that mileage will vary.  Family med is a three year residency; OB/GYN is four.  Surgery is five, and so on.  So, I'm staring down an extra year over what Southwick and her partner dealt with, but that's ok (years 1 and 2 were the hardest).  There are some citations and a list of sources at the end, but many of those are a bit dated.
• For resident widows, the book shares a bit too much "here's my schedule" and "here's my buddy list on this rotation" stuff.  If you're like me, you know who your Dr. Spouse works with and who the goodies and baddies are among faculty and fellow residents on their service. And just like I glaze over at some point while hearing Dr. D talk about something that happened that day (hey, she does it with student stories or writer talk, too) I tended to glaze over in these sections of the book. 
• With an e-price of $8.99, I suspect that the book probably won't fly off virtual shelves. I was going to buy this for all of the new residents coming in in July, and I still might buy paperbacks for them (or maybe I'll just tell them to check it out on their own).

For me, the book is quite good if you're unsure of what residency is like on a day-to-day basis.  I found myself irritated a bit that if Dr. D had just chosen family medicine that 24 hour call would mean she got to stay home and go in when needed (not 24 hours in house, which is what OB/GYNs do) and we'd be nearing graduation in six short months rather than eighteen, but that's just part of almost-senioritis.  

My wish-list includes more of Jude's voice.  While I realize that the book was ultimately about Southwick's experience, I bought it because she indicated that the book was also about her relationship and that entire experience.  Sadly, by the end I have no more clear sense of Jude's experience than I did at the start.  If a second edition comes out, I'd love to see alternating chapters where Jude responds and shares her experience of each aspect and her reflection of those moments.