This Is Going to Hurt: Secret Diaries of a Medical Resident by Adam Kay

Profanity
Gore

Bestselling author Adam Kay tells us the hilarious — and sometimes horrifying — truth about life and work in a hospital.

Welcome to 97-hour weeks. Welcome to life and death decisions. Welcome to a constant tsunami of bodily fluids. Welcome to earning less than the hospital parking meter. Wave goodbye to your friends and relationships. Welcome to the life of a first-year doctor.

Scribbled in secret after endless days, sleepless nights and missed weekends, comedian and former medical resident Adam Kay’s This Is Going to Hurt provides a no-holds-barred account of his time on the front lines of medicine.

Hilarious, horrifying and heartbreaking by turns, this is everything you wanted to know — and more than a few things you didn’t — about life on and off the hospital ward. And yes, it may leave a scar.

My Review

Horrifying doesn’t begin to describe many of the author’s experiences and actions in this book! As a comedy writer for tv, he is very good at telling a story in a funny way. However most of the stories also include gory descriptions, profanity (including taking the Lord’s name in vain), or a lack of concern for the feelings of patients and even so called friends. In fact, if you read one particularly crude and unnecessary story, you may never want to have a doctor touch you again.

At first I took the book at face value believing this was a factual recording of actual events in the author’s life. Some people do like to journal. But after reading more, especially after the placenta story*, I am wondering if he did keep a journal and how much is reconstructed or changed for entertainment value. He does seem prone to exaggerate at times. Remember, Adam Kay now writes comedy for television.

Unless he was obsessive compulsive, I doubt he kept a faithful diary because of the general lack of time for ordinary life and complete exhaustion he mentions.

*Anyone who knows the rarely used (by moms in the natural birth community) term placentophagia is also sure to know what a placenta looks like and that placentas are generally dried and encapsulated NOT eaten raw like a lioness no matter how humorous it may seem.

Let’s take a look at what This Is Going to Hurt shows us about the medical world.

Apparently doctors don’t always follow their own advice and google medical conditions occasionally. But if you are a patient do not mention Google or your judgment and sanity will be called into question.

…it came as quite the blow to discover that I’d spent a quarter of my life at medical school and it hadn’t remotely prepared me for the Jekyll-and-Hyde existence of a house officer [intern].

… A ship that’s enormous, and on fire, and that no one has really taught you how to sail.

Adam describes the whole experience as “perversely exhilarating” which feels like this was a bit of a narcissistic power trip. Interestingly he shows us the foibles of other medical staff in questionable integrity but his honesty is nearly always above reproach. There is the episode where he hypothetically talks about a humiliating passive aggressive surgical act he could have done in regards to a patient but claims to have not followed through with as it could lead to potential litigation. This “funny” situation places him as a potential ‘social justice hero’. Frankly, an intolerant passive-aggressive doctor is frightening!

Their ideal [medical school] student is captain of two sports teams, the county swimming champion, leader of the youth orchestra, and editor of the school newspaper. It’s basically a Miss Congeniality contest without the sash.

Surprisingly, he says kids decide on their future career in the UK at age sixteen. It seems a bit immature age to decide especially if you are choosing a career that affects life or death for others!

One of the job non-benefits that surprised Adam Kay was frequent over time that strained personal relationships. He complains about total fatigue and uncompensated work hours throughout the book because of understaffed hospitals. He says they don’t even have time to eat or take breaks most of the time. Very dangerous to have over tired medical personnel!

Perhaps you might say we need to hire more doctors. Forbes has suggestions for fixing medical schools and through this improving the medical system. The most notable suggestion is to stop incentivizing medical schools and students to focus more on specialty practice over general medicine. Yet it isn’t clear how to accomplish this. The true bottleneck to medical schools receiving more students is not addressed either.

Adam Kay’s assertion that he respects patients’ choices rings hollow as he describes scare tactics he employs to bully patients into his way of thinking. Forceps with birth and cesarean deliveries seem to be the standard of care despite the briefly acknowledged risks they entail.

Baby wasn’t coming out with forceps, so he performed an emergency cesarean. Unfortunately, when he got inside the abdomen, the baby had somehow delivered vaginally in the meantime.

Mocking patients for being overweight, using natural remedies, or religious beliefs were other demeaning stories. Yet the author seems unsatisfied not knowing the end result for his patients. One of his more human aspects. His further feelings of awkwardness in dealing with grieving patients and wish to do more is a familiar feeling for most of us. He talks about the necessity of developing a “hardened emotional exoskeleton” to deal with all the hard stuff that happens with patients. Maybe that acounts for half the abhorrent attitude he exhibits toward other patients in this memoir.

More of the job stresses and inconsistencies is shown as he points out patients often forget doctors are real people with homes and emotions. The same is often said about doctors not treating patients as humans. Perhaps we could each treat everyone with tolerance and respect as fellow brothers or sisters and see how it improves our society.

This Is Going to Hurt concludes with a plea to not allow government, i.e. British government, “to take a pickax to the (nationalized) health-care system.” I suggest taking a different approach. More government controls, more legislation will never fix what was broken through that process in the first place.

As more doctors and hospitals embrace meditation, yoga, healing touch, and now we may begin to see health coaches involved in patient care there may begin to be more tolerance toward patient choice in the medical system in general. Let us hope!

Tyler Cowen’s new book Big Business: A Love Letter to an American Anti-Hero and John C. Goodman’s Priceless: Curing the Healthcare Crisis look like they have some interesting advice on the topic of healthcare reform. I am intrigued by what I’ve read about both books and hope we can integrate more free market principles in the healthcare system.

It is interesting to note that amidst the push for Medicare For All, there has been a significant reform to Medicare in recent history that brought some measure of relief to people in the system. Medicare Part D’s success in reducing costs and improving health outcomes seems to be in large part because of the increased choices and free market principles it afforded.

When I first read the title, This Is Going to Hurt, I did not realize it referred to how it would feel to read (and review) this book. I urge you to consider reading Priceless: Curing the Healthcare Crisis by John C. Goodman instead!

I received a free advanced reader copy of this book. All opinions are completely my own.

I hope you enjoyed reading this! What is your take on the story?