Scandalous secrets of how hospital doctors are treated

This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay: book review

If you’ve ever required treatment at a National Health Service hospital, you’ll know how frustrating that can be:

  • Lengthy waits to see a specialist/consultant.
  • Clinic appointments  running hours behind schedule
  • Surgery dates postponed or cancelled.

Sound familiar?

It’s easy to feel after those experiences, that the much-lauded public health service in the UK has reached a breaking point. That it’s on the point of collapse.

Adam Kay’s memoirs make it evident it’s the selfless efforts of junior doctors that prevent it from collapsing.

Equally clear however is that their dedication comes at a huge personal cost.

This is Going to Hurt is a painfully honest memoir from one junior doctor  on the frontline of the NHS.  Adam Kay worked in hospitals for six years. He hung up his stethoscope in 2010 after a traumatic experience with a mother and baby in his surgery.

I’ve read enough newspaper reports to know that junior hospital doctors (those below consultant level) are poorly paid and over-worked. In 2016, in a bitter dispute over employment contracts, they staged the first strike in the history of the NHS. The dispute was settled only this week.

Undermined by bureaucracy

What I hadn’t realised until reading Adam Kay’s book was how much these professionals are undervalued and their expertise undermined.

Junior doctors give up their personal time and put marriages and friendships at risk rather than walk away from patients whose lives are in danger.

Yet scandalously ….

….they get charged for parking their car at the hospital.  And fined when they over-stay ( even when their delay was caused by an emergency patient);

… doctors have to find their own cover when they inconveniently fall ill and

… they are not allowed to sleep on a  spare patient bed after an 18 hour shift. They have to make do with a chair.

I was astounded to discover just how relentlessly gruelling are the lives of junior doctors.  The system makes it virtually impossible for them to have any kind of life outside their work.

It was not unusual for Kay to work a 100 hour week.

He describes times when he fell asleep in his car, in the hospital grounds, or at the traffic lights. Once he nodded off while sitting on an operating theatre stool waiting for his patient to be wheeled in.

On one occasion he was recalled from a long overdue holiday in Mauritius because the doctor meant to be covering his shift was ill. The  hospital refused to pay for a locum. He lost count of the number of  anniversaries, birthdays, weddings and theatre performances he missed “because of work.”

What kept him going was the positive feeling he would get after a shift in which he delivered multiple babies or aided infertile couples to become parents.

Comedy amid the tragedy

Although Kay doesn’t hold back from describing tense situations, when the life of his patient hung on a thread, he balances the darkness with flippancy and witty repartee.

When the doctors and nurses are not attending to patients, they’re busy swapping jokes and anecdotes about the bizarre conditions presented by some of their patients. I suspect this is the kind of black humour often used by police officers and firemen.  It’s a kind of release valve for people working in the emergency services.

Adam Kay has plenty of stories.

There’s the one about the drunken woman who climbed over a fence to get away from policemen. She slipped and ended up in emergency with a metal pole thrust through her vagina. After removal she calmly asked if she could take the pole home as a souvenir.

Or the tale of another woman who secreted a Kinder egg containing an engagement ring, intending to give her boyfriend the surprise of his life. It worked, though maybe not the way she intended, when the egg got stuck…

As a specialist in obstetrics and gynaecology he encountered a surprisingly large number of people who arrived at hospital with foreign objects in their rectums. The staff are so familiar with the problem they’ve even found a name for it: “Eiffel syndrome” (to understand the joke you need to say the following words aloud – “I fell, doctor! I fell!”).

Not all encounters generate humour. Medical staff are often confronted by aggressive patients and family members, or patients who make unreasonable demands. There’s a particularly yucky case he mentions in which an expectant mother wants to eat her placenta. He gets his revenge by ‘accidentally’ revealing the gender of the baby to the most aggressive of the expectant parents.

Lack of investment

This Is Going to Hurt swings between flippancy and  frustration. Some of Adam Kay’s criticism is  directed at hospital administrators for their propensity to introduce ever more new rules. But he lays the greatest blame on the shoulders of politicians who had failed to invest in the NHS over several years, leading to staff demoralisation.

My over-riding impression however is that Adam Kay loved the NHS and preferred to work in the public sector even when private practice would have been more financially rewarding.

Asked to represent the medical profession at a school’s careers event he decides honesty is the best approach:

So I told them the truth: the hours are terrible, the pay is terrible, the conditions are terrible; you’re under-appreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.

This was a fabulously engaging book that was a good companion to Do No Harm by the neurosurgeon Henry Marsh that I read earlier this year.

Funny, informative and poignant it ends on a note of frustration, particularly when Kay describes the agonising event that prompted his resignation. It let to the death of both baby and mother following a caesarian operation. Although Kay had followed all the correct procedures, he still blamed himself. He suffered a period of depression but was not given any therapy by the hospital or allowed time off to recover. After a few months he handed in his resignation.


This Is Going to Hurt: footnotes 

This is Going to Hurt was published in 2017 by Picador.

It’s written in the form of diary entries that were maintained by Kay during his medical training and his time as a hospital doctor.  The diaries were intended as a  “reflective practice” in which he could log any interesting clinical experiences he experienced. He used the material, suitably anonymised to write his book.

He has since embarked on a career as a comedian and scriptwriter. His new book Twas the Nightshift Before Christmas, is published in October 2019.

Read an interview with him in The Guardian newspaper.

About BookerTalk

What do you need to know about me? 1. I'm from Wales which is one of the countries in the UK and must never be confused with England. 2. My life has always revolved around the written and spoken word. I worked as a journalist for nine years then in international corporate communications 3. My tastes in books are eclectic. I love realism and hate science fiction and science fantasy. 4. I am trying to broaden my reading horizons geographically by reading more books in translation

Posted on July 1, 2019, in Book Reviews, Non fiction and tagged , , . Bookmark the permalink. 29 Comments.

  1. This sounds very revealing in many ways. I’m not at all sure it’s a book I would want to read. I have had differing experiences with the NHS over the years so can imagine it as being quite alarming for those of us who need their services regularly.

    • Even though the book shows a service in crisis I also felt reassured that there are people around like Kay who go way beyond the call of duty. All my frustrations with the NHS have been about the lack of efficiency in the administration

  2. Judy Krueger

    I have two nieces who are doctors, a nephew who is a respiratory tech. Even in America, the training of doctors is brutal in terms of schedules, etc. Why can’t we organize these professions, including teaching, where people do so much service to others, in a humane and equitable way? Thanks for your review.

    • The drop out rate must be huge which means the cost to the system as well as to the individuals is enormous. There does have to be a better way surely

  3. I definitely feel iffy about how this doctor behaved in some scenarios. Being a parent is hard, and while it doesn’t excuse their poor behavior, acting out of anger isn’t professional or justified. Also, his feelings about a woman eating the placenta may be “icky” to him, but it’s something people do in other cultures. I know it’s the norm in some African countries, so perhaps a bit of empathy on his part is due.

    • I dont think he was acting out of anger but sometimes when you are highly stressed you act in a different way. Bear in mind he would have been on his feet, without much to eat for 18 hours and multiple patients waiting for him in surgery.

      • I understand that, but I’m looking at both sides. The people who came in for medical care didn’t ask for a stressed out, half-asleep doctor. It’s unfair to everyone, and I hope the legal changes you mentioned help people like this author!

        • It’s a miracle that more medical mistakes don’t happen because the medics are so tired/stressed. One day some brave politician will step up to the challenge and do something…

        • I know that in the U.S. there are loads of accidents and issues in both the medical and trucking industries because people work too long. The rules are getting stricter, but there are always loopholes. For instance, the amount of time a trucker is required to take a break matches just about the same amount of time needed to fill up on fuel and use the restroom. A break, indeed.

        • That’s a ridiculously short break when you think how much concentration is needed to keep those large trucks moving safely

  4. Wow. Just shared this on FB.

  5. Wonderful review of a book filled with both pain and humour.

  6. The Right have discovered they can’t abolish ‘free’ health care so instead they award themselves constant tax cuts then reduce health payments to keep the books “balanced” (another convenient myth). The hours young doctors work are ridiculous, they are taken advantage of because it’s the only way for them to qualify.

    • How is the Australian health system funded – is it like the UK system where we pay via contributions from salaries? Does it work effectively? I have a friend who needed medical attention when she was in Aus last year. It was impressive that she saw a doctor immediately, got referred for and had blood tests and a CT scan the same day and had a follow up appointment to review the results. I know she had to pay since she was a visitor but it was still amazing. You wouldn’t get there here in UK

      • Health funding in Australia is a dog’s breakfast. Hospitals are ostensibly run by the states but the Commonwealth exerts control by making payments direct to hospitals instead of via the states. As in schooling, the conservatives favour private hospitals over public and give huge and inefficient rebates to people who take out private medical insurance. That said, the public system still treats people eventually and many privately insured people insist on public care when it suits them, and yes doctors work ludicrous hours (unlike truck drivers whose hours are regulated) and ambulances sometimes queue up round the corner with patients they can’t get rid of.

  7. I’ve heard so much about this one, it does sound incredibly entertaining!

  8. I have friends who would enjoy this book.

    • It’s odd to say that it’s enjoyable because he is making a very serious point but I think the humour gets his message across even more effectively than if he had just done a straight narrative

  9. I had been hesitant about whether or not I wanted to pick this book up but this review has really tempted me! It sounds like an utterly compelling read. As a frequent hospital patient it would be interesting to see the view from the other side so to speak. Excellent review! 🙂

    • I’ve had many encounters with the hospital system in recent years, as patient and visitor. The thing that I always come away feeling is that the front line staff do an amazing job but have to fight all the way against the systems put in place supposedly to be efficient but that don;t work. He gives some great examples of new computer systems that never should have been introduced because they slow the doctor down from prescribing medication or treatment….

  10. I can see you’ve been inventive with the title on this one. Interested to see if it makes a difference. Personally, while I like the idea of a different heading, I’d still like to see the title and author. While it’s possible to discover what your review is about if you click through – the Twitter link doesn’t and not sure if that might pass people by. I guess you’ll know how effective this approach has been when you see the stats. If it works we might all start being more inventive.

    • Rachel Bridgeman

      I agree with Jill on the title as I think it’s pretty well known how stretched the NHS is, maybe not to the extent that this author found it in their experience, but it’s well known. It’s on my tbr pile , well it was until the part about the placenta and the gender reveal. What a judgemental attitude to take and what a mean thing to do!
      That’s not funny at all!
      And if like it says, he spent all that time working in obs and gynae I am guessing that the things stuck inside people refers , in the main, to women?
      Is he using women as the punchline here?
      It comes across as a juvenile and misogynistic collections of anecdotes.
      Whilst acknowledging how hard drs work (and I have seen this as a midwife and a student nurse)it has put me off reading this.
      His public persona does seem as though he is the spokesperson for drs whether they like it or not, and whilst his fundraising at his live shows is admirable, the cost for tickets to see him were sadly outside the purview of many of his ex-NHS colleagues.

      • He saw plenty of men with objects in places they shouldn’t be and damage to male organs so he’s not targeting women at all nor is his attitude negative towards women. He actually comes across as a very caring person who would go into the hospital on his day off just to check on his patient. I can’t comment about ticket prices since I’ve no idea what they are – does he set the prices though or is that done by the venue? sadly so many forms of entertainment are expensive and prohibitive (opera and theatre ticket prices seem to have rocketed)

        • Having read the book and seen him live, I can absolutely say that he is neither unfair on women or juvenile. The book and his stage show are both funny and deeply emotional. He cared and still does about the NHS and the patients. Medical humour is perverse, it’s a protection against the things they have to deal with and see everyday. In both the live shows and the book he makes an impassioned plea for those Doctors who are still working critical and often dangerous hours

          Honestly he is using this book to raise awareness. Yes there are a few squeamish points in the book, but that’s the reality of life in the NHS.

          He cares deeply. I watched as he was overcome with emotion at the show in Cardiff. You can see it still hurts.

        • Thanks Susan for that perspective. I’ve certainly seen other professionals in highly stressed situations use humour that other people might consider ‘off’. But it’s a form of release valve….

    • It’s a tough question Jill – ideally I would like to have the title as well as something more compelling. But then the title gets way too long and would be cut off for people viewing a feed on a mobile. All I can do is to try it and see as you say

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