This Is Going to Hurt

Last updated

This is Going to Hurt: Secret Diaries of a Junior Doctor
This Is Going to Hurt (book cover).jpg
First edition
AuthorAdam Kay
LanguageEnglish
GenreNonfiction
PublishedSeptember 7, 2017
PublisherPicador
Publication placeUnited Kingdom
ISBN 1509858636

This Is Going to Hurt: Secret Diaries of a Junior Doctor is a nonfiction book by the British comedy writer Adam Kay, published in 2017 by Picador. It is a collection of diary entries written by Kay during his medical training from 2004 to 2010. Kay's book discusses political issues in the health care system of the National Health Service in the United Kingdom and societal conflicts between the general population and neglected doctors. Kay accomplishes this by incorporating humour into his personal anecdotes that depict his life as he progresses through his medical training, and his eventual resignation from this career. [1]

Contents

Background

This Is Going to Hurt is mostly composed of diary entries Adam Kay wrote during his medical training under the National Health Service. It was recommended to Kay to write this diary as a "reflective practice" in which he could log any interesting clinical experiences he experienced throughout his training. Five years after his resignation, Kay was officially removed from the medical register which prompted him to dispose of all the medical files he had been storing, leading him to review his reflective journal. Around this time in 2015, junior doctors entered contract disputes with the NHS leading the Secretary of State for Health and Social Care, Jeremy Hunt, to accuse junior doctors of being greedy. This event motivated Kay to respond to this accusation by releasing This Is Going to Hurt, which illustrates his own experiences as a junior doctor. [2]

Outline

Adam Kay Adam Kay 20171207 01.jpg
Adam Kay

Kay began his medical training as a House Officer in 2004 with the United Kingdom's National Health Service after attending Dulwich College and Imperial College School of Medicine. In his comedic recollection of his time as a house officer, Kay describes four foreign objects he removed from patients' rectums, his first time saving someone's life, and long nights spent in the A&E. Kay became a Senior House Officer by August 2005, a year after officially becoming a doctor. It is at this point in his career that he decided to specialise in obstetrics and gynaecology, or "brats and twats" as Kay referred to it. [3]

In August 2007, Kay was promoted to Registrar, the third highest ranking position after Consultant and Senior Registrar. His diary entries in his time as these positions describe multiple successful births, failed births, infertility problems, and sexually transmitted diseases/infections, along with a gruelling workload that included sleepless nights, unpaid overtime, minimal gratitude from co-workers, sleeping in the car park, and inability to have someone cover a shift leading to minimal holiday and sick time. Throughout these experiences, Kay recalls times in which he gets close to quitting due to the vast amount of stress the job inflicted on his life, harming his health and social relationships. What kept him going was positive outcomes from helping patients in multiple ways ranging from helping couples become pregnant to delivering a multitude of babies a night. This feeling of being a "low-grade superhero" is what Kay claims helped him push through all the other inconveniences related to the job. [4]

In August 2010, Kay received his promotion to Senior Registrar. In the diary, Kay takes note of the increased responsibility that came with the promotion and how it added a new form of pressure since he was now supposed to be the person contacted in severe emergencies, where the Senior House Officer and Registrar were unable to solve the problem.

On 5 December 2010, Kay began to perform a caesarean on a patient who had undiagnosed placenta praevia. Kay first delivered the placenta and then the baby, which was dead and unable to be resuscitated. The detached placenta caused heavy haemorrhaging; Kay and the senior consultants called into theatre failed to stop the bleeding and, after 2 hours and 12 litres of blood loss, a hysterectomy was performed. The mother was transferred to the intensive care unit and Kay was told to expect the worst. After this event Kay became depressed. Whilst he had followed best practice, and the missed placenta praevia should have been found in previous scans, Kay obsessed that he might have prevented the death of the baby and endangerment of the mother's life by somehow diagnosing the placenta praevia prepartum. Several months after this event, Kay resigned his position. [5]

Themes

The most prevalent theme present in This Is Going to Hurt is the mistreatment and neglect that doctors have to endure. Throughout his time working for the NHS, Adam Kay was deprived of multiple basic amenities that other occupations have. Kay was forced to stay hours after his shift would end with no pay, be unable to have a sick day or go on holiday because it was extremely difficult to find someone to cover his shift; while on shift, he would be unable to sleep even if he had free time; and, in general, junior doctors like Kay felt severely underpaid for their services. Kay notes that his starting wage as a junior doctor was so poor that he would be better off financially working at McDonald's. This sense of neglect was emphasised after Kay's career-ending event since he wasn't allowed to take any time off to emotionally recover. The next day he was forced to go back to work even though he was not in the right mindset to and had asked for a week off. No therapy was offered to Kay to possibly help him after the traumatic event, further debilitating his emotions and mind. [1]

The traumatic event emphasises another theme present which involves the humanising of doctors. In This Is Going to Hurt Kay discusses how the general public expects doctors to be more than human. They expect doctors to be available at all times at their full efficiency, disregarding the fact that they are also humans. Kay claims that people forget doctors also have to spend time with their families and friends, they have to sleep, eat and take care of themselves, and more importantly they expect doctors to be error-free. Doctors' fallibility is unavoidable since they are human and are always prone to making mistakes. Not only did Kay make a mistake by missing the diagnosis of placenta praevia, but he had previously slightly cut the cheek of a newborn baby during a caesarean, mainly due to lack of sleep during his night shift. [6]

The book combines these themes to form a powerful argument against Jeremy Hunt's comments concerning the motivation of doctors, justifying the view that doctors are not greedy, and do not pursue a career in medicine entirely motivated by money. Through this book Kay highlighted the many adversities junior doctors must face for the minimal pay they receive, and sought to spread awareness to support doctors in their contract disputes with the NHS. [5]

Critical reception

Upon its release in September 2017, This Is Going to Hurt was praised for having comedy while also spreading awareness of the lives of junior doctors. A review in The Scotsman said that the book "will make your eyes water... and it may well make you choke on hot tea." The social importance of the book is stressed in the review as being "vital and timely; it should be required reading for anyone who ever has any political or financial responsibility for [England's] health services." [3]

Recognition

Listed are all the recognitions This Is Going to Hurt has received since its release:

Adaptations

Shortly after its release in September 2017, Naomi De Pear of Sister Pictures acquired the television rights to This Is Going to Hurt. Sister Picture, an independent production company founded in 2015, acquired these rights in a 12-way auction between other interested producers. The television series based on This Is Going to Hurt is being written by Adam Kay and developed by Katie Carpenter along with Naomi De Pear, who will also executive produce the series. [8] On 6 July 2018, the BBC announced that the adaptation would be made by Sister Pictures and shown on BBC Two as a seven-part comedy-drama. [9] In February 2022 this adaption was broadcast as a seven-part comedy-drama on BBC1.

In 2024, an extract was taken from the book and used as a source for a GCSE Language Paper 2 exam.

Related Research Articles

<span class="mw-page-title-main">Placenta praevia</span> Medical condition

Placenta praevia is when the placenta attaches inside the uterus but in a position near or over the cervical opening. Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Complications may include placenta accreta, dangerously low blood pressure, or bleeding after delivery. Complications for the baby may include fetal growth restriction.

<span class="mw-page-title-main">Phil Hammond</span> British General Practitioner, broadcaster, and comedian

Philip James Hammond is a British physician, broadcaster, comedian and commentator on health issues in the United Kingdom. He is best known for his humorous commentary on the National Health Service. He first came into the public spotlight writing a column for The Independent newspaper, where he wrote with a strong pro-patient rights line and as Private Eye's medical correspondent "MD".

<span class="mw-page-title-main">Residency (medicine)</span> Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training. Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.

Antepartum bleeding, also known as antepartum haemorrhage (APH) or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery.

In the United Kingdom, junior doctors are qualified medical practitioners working whilst engaged in postgraduate training. The period of being a junior doctor starts when they qualify as a medical practitioner following graduation with a Bachelor of Medicine, Bachelor of Surgery degree and start the UK Foundation Programme. It culminates in a post as a consultant, a general practitioner (GP), or becoming a SAS Doctor, such as a specialty doctor or Specialist post.

<span class="mw-page-title-main">Jeremy Hunt</span> Chancellor of the Exchequer since 2022

Jeremy Richard Streynsham Hunt is a British politician serving as Chancellor of the Exchequer since 2022. He previously served in the Cabinet as Secretary of State for Culture, Olympics, Media and Sport from 2010 to 2012, Secretary of State for Health and Social Care from 2012 to 2018 and Foreign Secretary from 2018 to 2019. A member of the Conservative Party, he has been Member of Parliament (MP) for South West Surrey since 2005.

<i>The Citadel</i> (novel) 1937 novel by A. J. Cronin

The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking in its treatment of the contentious subject of medical ethics. It has been credited with laying the foundation in Britain for the introduction of the NHS a decade later.

Modernising Medical Careers (MMC) is a programme for postgraduate medical training introduced in the United Kingdom in 2005. The programme replaced the traditional grades of medical career before the level of Consultant. The different stages of the programme contribute towards a "Certificate of Completion of Training" (CCT). It has been dogged by criticism within and outside the medical profession, and an independent review of MMC led by Professor Sir John Tooke criticised many aspects of it.

<i>Cardiac Arrest</i> (TV series) British TV series

Cardiac Arrest is a British medical drama series produced by World Productions for BBC One. It aired from April 1994 to June 1996. The show focused on the lives and challenges of junior doctors working in a hospital setting and was known for its realistic and sometimes dark portrayal of the medical profession. The series was controversial owing to its cynical depiction of doctors, nurses and the National Health Service (NHS), although it has often topped polls of the UK medical profession as the best medical drama of all time.

A Senior Registrar was a grade of doctor in the United Kingdom or Ireland before being superseded during reforms in the 1990s. The senior registrar post still exists in Australia, whilst in the US, the title of “Senior Registrar” might be applied to a Senior or Chief Resident in Surgery.

<span class="mw-page-title-main">History of the National Health Service</span>

The name National Health Service (NHS) is used to refer to the publicly funded health care services of England, Scotland and Wales, individually or collectively. Northern Ireland's services are known as 'Health and Social Care' to promote its dual integration of health and social services.

A specialty registrar (StR), previously known as and still commonly referred to as a specialist registrar (SpR), is a doctor, public health practitioner or dentist who is working as part of a specialty training programme in the UK. This is known as a training grade as these doctors are supervised to an extent, as part of a structured training experience that leads to being able to undertake independent practice in a hospital specialty or working as a general practitioner.

Max Pemberton is a British medical doctor, journalist and author. He works full-time as a psychiatrist in the National Health Service (NHS). He is a weekly columnist for the Daily Mail, writing comment on news events concerning culture, social and ethical issues, the politics of health care and the NHS. Before his move to the Daily Mail, he was a columnist for the Daily Telegraph. He also writes a monthly column for Reader’s Digest and is a regular contributor to The Spectator. He is the editor of Spectator Health, a quarterly supplement from The Spectator.

<span class="mw-page-title-main">Adam Kay (writer)</span> British comedy writer, author, youtuber, comedian and former doctor (born 1980)

Adam Richard Kay is a British TV writer, author, comedian and former doctor. He is the author of the memoir This Is Going to Hurt (2017), about his time as a trainee doctor. His television writing credits include This is Going to Hurt, Crims, Mrs. Brown's Boys and Mitchell and Webb.

<span class="mw-page-title-main">St Helens and Knowsley Teaching Hospitals NHS Trust</span> NHS hospital trust

St Helens and Knowsley Teaching Hospitals NHS Trust was an NHS Trust that operated from 1991 until 2023, based in Whiston, Merseyside. The trust became part of Mersey and West Lancashire Teaching Hospitals NHS Trust on 1 July 2023.

Sir John Graham Temple is a British surgeon, a former President of the Royal College of Surgeons of Edinburgh.

<span class="mw-page-title-main">Johann Malawana</span> British entrepreneur and former physician

Johann Niranjan Lyle Malawana is a British entrepreneur and former obstetrics doctor. Malawana was the Chair of the British Medical Association's Junior Doctors Committee from September 2015 to July 2016. His tenure included the 2015 junior doctors contract dispute in England where he was the lead negotiator on the new contract. Malawana founded technology company Medics.Academy and The Healthcare Leadership Academy in 2016.

Doctors in Distress is a British charity established in 2019 with a primary mission to reduce the prevalence of burnout and suicides among healthcare professionals in the United Kingdom. The organisation's inception was a response to the tragic suicide of Dr Jagdip Sidhu, a highly regarded cardiologist, in November 2018. This event deeply impacted his brother, Amandip Sidhu, who founded the charity. Doctors in Distress is dedicated to raising awareness of the significant pressures faced by medical practitioners and fostering more compassionate and supportive work environments where healthcare professionals can openly discuss challenges such as stress and mental health.

<i>This Is Going to Hurt</i> (TV series) British medical comedy-drama miniseries

This Is Going to Hurt is a British medical comedy-drama television miniseries, created by Adam Kay and based on his memoir of the same name. The show was co-produced by the BBC and AMC. It focuses on the lives of a group of junior doctors working on an obstetrics and gynaecology ward in a National Health Service hospital. It profiles their professional and personal lives and explores the emotional effects of working in a stressful work environment. The series closely follows the stories of Adam Kay and Shruti Acharya as they work through the ranks of hospital hierarchy. These characters both break the fourth wall and directly address viewers with dialogue. This Is Going to Hurt presents its stories with comedic and dramatic tones. The seven-part series premiered on BBC One and BBC iPlayer on 8 February 2022. It began airing on AMC+ in the United States on 2 June 2022.

References

  1. 1 2 Anthony, Andrew (10 December 2017). "Adam Kay: 'If I had kids I would put them off studying medicine'". the Guardian. Retrieved 26 April 2018.
  2. "Book Review – This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay". The Literary Sofa. 22 November 2017. Retrieved 26 April 2018.
  3. 1 2 Black, Claire (4 October 2017). "Book review: This is Going to Hurt, by Adam Kay". The Scotsman. Retrieved 1 May 2018.
  4. Donnelly, Sophie (9 September 2017). "From NHS hospital to comedy writer: Doctor turns his medical diaries into a hilarious book". Express.co.uk. Retrieved 26 April 2018.
  5. 1 2 Hawksley, Rupert (5 December 2017). "'Hot wax was dripping down into his bladder' – former doctor Adam Kay on 'revolting' injuries and the future of the NHS". The Telegraph. ISSN   0307-1235 . Retrieved 26 April 2018.
  6. Heathcote, Charlotte (15 September 2017). "This Is Going to Hurt review: A heartbreaking but hilarious life of a junior doctor". Express.co.uk. Retrieved 26 April 2018.
  7. "This is Going to Hurt". Pan Macmillan. Retrieved 26 April 2018.
  8. "Adam Kay's This is Going to Hurt optioned for TV". Pan Macmillan. Retrieved 26 April 2018.
  9. "BBC Two announces adaptation of bestseller This is Going to Hurt by Adam Kay". BBC Media Centre. Retrieved 6 July 2018.