The DO Book Club, April 2024: ‘This is Going to Hurt: Secret Diaries of a Junior Doctor’

First published in 2017, “This is Going to Hurt” is a collection of diary entries made by author Adam Kay during his time spent as a junior doctor in the National Health Service (NHS) in the United Kingdom (UK). Kay, an England native, shares his residency and attending experiences. The narrative begins with a look into his life before starting his medical training; his dark, humorous and inappropriate stories contrast with a heartbreaking story shared at the end of the book that ultimately caused Kay to leave the profession.

Kay worked as a doctor between 2004 and 2010; he currently lives in England with his husband and two children. He is an advocate, writer and comedian. 

Readers will appreciate his descriptions of the everyday life of a trainee and physician, the patients and the system. In addition, the deeper themes and critiques of the system and profession will resonate with readers.

Throughout the book, Kay describes his progression over six years as he transitions from a junior doctor through an OB-GYN residency before finally exiting his career. The British equivalent of an intern is the foundation year 1 doctor, who is on the first year of their two-year Foundation Program and has provisional registration with the General Medical Council (GMC). He talks eloquently about the pressures of training, providing relatable, interesting perspectives.

A day in Kay’s life

There is humor in this book—some of it crude and some of it irrelevant. Those who do medical work will recognize that this humor is a way to cope with the intensity and gravity of working in medicine and the daily tragedies the author encounters. The OB-GYN content of Kay’s crude humor likely reflects this. The author also demonstrates empathy, commitment and compassion for his patients. His stories are similar to situations encountered by physicians on a routine basis and reflect the culture and the phenomenology of day-to-day medicine.

In his daily journal diatribe, Kay usually starts with describing an event and providing it with context and meaning. His daily fragmented notes will resonate with many.

Kay describes many instances in which the ideal in healing and health care is subsumed due to myriad forces, including the inadequacy of the health care system.

Physicians deal with similar situations daily—the quirks of interesting findings; the difficult discussions; end-of-life issues; personal consequences of action or inaction and the sacrifices that physicians make in order to care for others.

There are significant themes discussed in Kay’s book—eye-opening truths and discussions about the nature and service of medicine and the economics of health care.

In the UK, all citizens can access NHS health care; the NHS exists alongside profit-motivated private practitioners who care for those who can afford to pay for their health care.

Along with free education, free health care is a basic human right; however, Kay eloquently points out that despite being free, the system is imperfect, with long waits for common ailments and the intricacies that occur with doctors’ compensation and competitive independent consultants.

Many of Kay’s anecdotes take place in an OB-GYN’s daily work—pregnancies, deliveries, postpartum care and the sexually transmitted disease clinic. Not all experiences are pleasant; at times, Kay ignores details on the process of care. Yet, physicians can relate to situations when physician consultation and opinion is refused; information is ignored; and when patients or staff misunderstand.

Eye-opening conversation starters

Readers will laugh out loud while reading Kay’s book. At other times, readers will be saddened. Overall, the tone of the book is fairly light; however, there is a clear undercurrent to the book, the personal anger due to the self-sacrifice that physicians and the author have undertaken and how his own self-sacrifice affected his personal life. The book illustrates the toll working as a physician can take on a person—to be responsible for the lives of others at work, to work so hard that there is little time for oneself and self-care.

For nonphysicians, this book might be an eye-opener. Physicians have some guilty, hilarious pleasures that we all encounter—like the conversations heard in halls, lounges or dinner meetings. The bulk of Kay’s book is a cry for help for a health care system which needs to refocus priorities in order to continue to improve, to protect and serve, and to provide and support physicians. The daily grind of a physician contrasts with this call to action, reverberating in the system that continues to stretch doctors daily.

There is a lot of humanity within the book as it covers the personal and internal conflicts that physicians suffer. The author demonstrates care about the profession and for patients: “a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness.” (p. 7)

Reading as catharsis

Kay provides an interesting perspective on the NHS as a government-run universal health care system. The NHS seems to have limited resources, staffing shortages and low pay, which affect the quality of patient care. Caregivers are described as overworked and exhausted.

Compared to daily work in the United States health care system, many physicians might wonder if the UK NHS is much different than their own daily experience. The author tries to be a voice of change. Kay may not provide answers in his critiques of the health care system, but his not-so-subtle opinion threaded throughout provides a related framework as he details problems. Health care, while a business, is not a business; patient-centric care should be at the forefront of what we try to do and how we do it. 

This book is an interesting read. The gallows humor will go far for those who have worked in hospitals in any capacity. “This is Going to Hurt” may be cathartic to some and amusing to others. Kay’s book facilitates conversations with trainees who understand the author’s subtleties and shared experiences of training. However a health care system might be structured or funded, the experience of being a healer and a doctor is universal: the same heartbreaks, hilarity, damaging work schedule and frustrations with administrators, and a constant barrage and baffling array of objective findings and stories.

Related reading:

The DO Book Club, Feb. 2024: ‘Real Self-Care’

The DO Book Club, Jan. 2024: ‘Outlive: The Science and Art of Longevity’