Review of THIS IS GOING TO HURT: SECRET DIARIES OF A YOUNG DOCTOR by Adam Kay

 3 Stars

This book is an account of the life of a young doctor working for the National Health Service in the United Kingdom. It is structured as a series of diary entries between August 3, 2004, and December 5, 2010. He recorded things that happened to him; some were hilarious and some were heartbreaking.

The book reveals the reality of the NHS. What is exposed is an underfunded health care system with a management that does not make decisions in the best interests of medical staff or patients. The author claims doctors are underpaid and overworked. He describes working while exhausted and worrying about providing competent care without making errors which could result in life-threatening consequences. He bemoans “hospitals’ willful ineptitude when it comes to caring for their own staff.”

The personal toll of working in healthcare is highlighted. The author’s relationship with his partner suffers because of the long hours he works; even friendships are impacted when people outside the medical field do not understand the grueling working hours. He also mentions the high percentage of doctors who have experienced mental health issues and the high suicide rates because of the demands of their profession: “being given huge responsibility, minimal supervision, and absolutely no pastoral support.”

One thing that surprised me is the medical career path in the UK. Students choose medicine at 16, long before they understand what the profession entails. This is certainly different than in Canada where students must complete an undergraduate degree before applying to a medical school. This Canadian (and American) approach is the one the author approves: “getting a medical degree is a decision you should make in your early twenties, not as a teenager.” The amount of support junior doctors receive in hospital settings varies; the author describes a hospital where the approach was “see one, do one, teach one” as if watching a procedure automatically qualified someone to perform that procedure.

There are many anecdotes, but I didn’t really find them that surprising or original. One of my friends is an emergency physician at Sunnybrook Health Sciences Centre, the largest trauma centre in Canada, so I’ve heard some of these types of stories before. I also worked in a hospital for four summers when I was in university so I have tales of my own.

Some of the anecdotes are amusing, but after a while they feel formulaic and repetitive. There is always a punch line at the end. Early on I felt that these would work better as part of a stand-up comedy routine. Sometimes Kay just makes cheap shots at a patient’s intelligence, weight, or sexual activity. And there is a preponderance of jokes about bodily fluids and random foreign objects in body cavities.

I admit to not really liking the author. I understand that humour is a coping mechanism but it sometimes feels exploitative. He uses patients to gain a laugh, and some of his comments are inappropriate and/or insensitive. There’s a condescending tone in his dismissal of colleagues, suggesting some needed prescriptions for common sense and giving examples of incompetence. He makes comments about old people: “a bunch of grannies with pelvic floors like quicksand and their uteri stalagtiting into their thermals.” Some of his comments border on cruelty: he wants a father to stop talking during a delivery but suggesting that he might deliver a blue baby is over the top. Out of spite, he reveals the gender of an unborn child. He is especially judgmental about religion: he repeats how Jehovah Witnesses are stupid and jokes about asking a Muslim man for a BLT and a bottle of vodka. The author does show compassion in some situations, but they are undermined by his ridicule of others. I’m not sure I’d be comfortable having him as a doctor.

The book is good in spotlighting the sacrifices made by medical professionals whom we forget are human beings, not infallible superheroes. Learning about some of their moral and ethical dilemmas might change public perception. I just got the impression that the author didn’t think much of the people who came to him for care, though perhaps my dislike of humour that belittles others is colouring my impression.