Some thoughts on This Is Going To Hurt

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Firstly, This Is Going To Hurt by Adam Kay is a great book. A former obstetrician who gave up medicine in 2010 to pursue comedy, his description of what life used to be like is as with any well-written memoir of medicine heartbreaking and funny. Indeed, variations on “heartbreaking and funny” have become something of a cliché in reviews of the medical memoir.

It is worth noting how variable our experiences in the NHS are. A persistent theme in This Is Going To Hurt is the absence of bosses. This varies widely between specialities. Anaesthesia has always been ahead of the curve in terms of consultant presence out-of-hours but consultants in all acute surgical specialities (including obstetrics and gynaecology) seem, from my point-of-view anyway, to be more readily available than in years past though many internal medical specialties still seem to lag behind. “I didn’t want to disturb the boss” is no longer a legally defensible position.

When Kay started medicine (in around 2004), 24 hour on-calls were the norm. Not bothering the boss was the norm. Now, the European Working Time Directive means that 12 hour shifts are in place for nearly every acute specialty. Though much-maligned, the new junior doctor contract has led to exception reporting which fines trusts for junior doctors who persistently working hours longer than contracted.

(The fines go back to the junior doctors’ mess and the doctors in question should they accrue sufficient hours get days in lieu.)

Many of the bugbears he discusses are still in place. The lack of study leave for exams – public health get two days a week for three months coming up to their exams; I get the day of the exam off plus a day for travel. The difficulty in getting swaps for annual leave, made even more complicated by the fact that on a 1 in 7 rota with 12 hour shifts, for any given day off, 1 or 2 of the other 6 doctors are likely to be unavailable for swaps.

Some are worse, particularly the inflexible and pernickety nature of postgraduate education. Not got a DOPS in Management of Cardiorespiratory Arrest despite having a valid ALS and this being a thing that happens out of hours so there is almost never a consultant around to watch you do it? Too bad, you may have to repeat the year. Not got any assessments in major trauma despite not having worked in a major trauma centre? Too bad, you may have to repeat.

I guess the bottom line is – some things are better, some things are worse and the experience is dependent on specialty and location as much as anything. Slowly (too slowly) the machismo in medicine is dying away. But there is still a feeling of too much work for too little pay with the addition of tiresome educational assessments, the value of which is never truly made clear to assessors and those being assessed alike.

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