Book Review: This is Going to Hurt

This is Going to Hurt, by Adam Kay, was written after the author rediscovered his medical training portfolio – a sort of diary in which he logged his clinical experiences – while clearing out old paperwork. The GMC had recently removed his name from the medical register, several years after he tendered his resignation. The book is a fascinating account of the day to day life of a junior doctor. It is laugh out loud funny, devastatingly sad, and a wake up call to anyone who may ever have cause to seek medical care in the UK. It should be required reading for any voter or politician who believes that tax cuts matter more than health.

The book opens with a brief discussion about why young people choose to enter the profession, and how candidates are selected. The chosen few must then cope with a demanding five or six year university course after which they enter a hospital, newly qualified to administer treatment. They work their way up through a system designed to ensure a more senior doctor is available to call on if needed, right up to consultant level. In practice there are medical emergencies that must be dealt with immediately and too few members of staff. Added to this is the fact that shifts can last for days without rest – nobody goes home when patients may die if they do. The pressures of the job are unimaginable, and the personal cost to the staff immeasurable.

Each chapter covers a level in the progress of a junior doctor’s career. The author offers a brief introduction and then includes a series of diary entries from that period. Many of these are amusing:

“Friday, 10th September 2004

I notice that every patient on the ward has a pulse of 60 recorded in their observation chart so I surreptitiously inspect the healthcare assistant’s measurement technique. He feels the patient’s pulse, looks at his watch and meticulously counts the number of seconds per minute.”

Footnotes explain medical terms and procedures. There are references to the social and family events missed (stag dos, weddings, funerals, holidays) because a shift had to be covered at the last minute. Reading this, it is little wonder that doctors have high divorce and suicide rates.

When a choice of specialism was called for, Dr Kay opted for obstetrics and gynaecology – a blend of medicine and surgery working in labour wards and in infertility clinics.

“Labour ward is literally four things: caesareans, forceps, ventouse and sewing up the mess you’ve made.”

As he admits, not all storks have happy landings, but he had ruled out every other possible route to consultant, and the alternatives did not appeal. The diary entries from here involve his work with women and their families who are trying to have, are having, or have had babies. His experiences beg the question why any of us put our bodies through such trauma, and what health challenges old age may now bring!

Despite their best efforts, and willingness to be covered in any number of varieties of bodily fluids, doctors are not always treated with gratitude and respect by those they help. They must also deal with those: who think they know better because they read something in the Daily Mail; who believe they can control outcomes with dreamy birth plans (candles by an oxygen tank anyone?); or whose religious beliefs could result in their death. There is also the point that doctors are human beings who will sometimes make mistakes. The growing litigious culture only adds to the pressure, and drives more of them to leave.

The structure of diary entries make this book eminently readable. The numerous amusing anecdotes interspersed with detail of heart rending cases are highly engaging. As well as portraying the life of a junior doctor with its unremitting demands and thankless expectations, there are the frustrations of a system that is constantly trying to find ways to cut costs, thereby making clinicians lives even more difficult. Then there are the patients…

“Saturday, 4 November 2006

Get bleeped to see a postnatal patient at 1am. The ODP relays to the bleeping midwife that I’m in the middle of a caesarean. I get bleeped again at 1.15am (still doing the section) and 1.30am (writing up my operation notes). Eventually, I head off to review the patient. The big emergency? She’s going home in the morning and wants to have her passport application countersigned by a doctor while she’s still in here.”

Despite his heroic efforts the author does not come across as any sort of angel. There are personal anecdotes that made me cringe, perhaps to demonstrate that doctors can be good at their jobs without being perfect human beings. They lose friends and partners after months or years of constantly cancelled dates – let downs after promises to (for once) be there – due to work or exhaustion. The job is portrayed as manic and relentless.

Add to this the current climate of blame, especially from politicians (most especially from Jeremy Hunt). The author resigned after a particular experience but it was the culmination of years of life changing stress. It is a wonder that anyone can work in such an environment, and perhaps that is why so many doctors are leaving the profession. Given how long it takes to train a doctor, the impact of this on the nation’s health will be difficult to turn around.

As the parent of a medical student I read this book with some trepidation – what sort of life have I encouraged my daughter to pursue? Doctors have been telling us for years what is happening but it seems only to get worse, their warnings ignored. This book is funny and heartfelt, I stayed up late to finish it in a day. I hope it will encourage others to place more value on the NHS before it is lost, at the ballot box as well as when they or those they love require treatment. A recommended read.