This is going to hurt

I recently finished reading “This is going to Hurt” by Adam Kay.  This book is a collection of diary entries and anecdotes written by a former British NHS OB/GYN.  It documents his medical career from the time he started post medical school training up until the time that he left medicine for good.  It is a chronical involving humor, despair, anguish, enlightenment and self-realization.

A career in the healthcare industry can be vastly rewarding yet at the same moment be personally tragic.  It is not for everyone as Mr. Kay so eloquently points out.  Medicine takes a special calling, a combination of intelligence, personality, drive, desire, determination, resolve and compassion.  It is very difficult to come up with that combination in an individual. 

Mr. Kay was a victim of the system, a system that is broken on many levels.  He was driven out of medicine by long hours, poor pay, overwhelming bureaucracy and personal tragedy.  He admits that he went into medicine for the wrong reasons, essentially a sense that he needed to follow in predecessors footsteps. 

I wanted to like this book.  I really did.  I did like it but not to the extent that I should have.  The anecdotes hit me on a personal level.  I have lived them.  If not the stories in their exact form, at least in a generalization of some aspect.  I can look through his words and see the patients he is describing.  He talks about professional triumphs and professional disasters.  These include the saving of a life or the loss of a child.  I have had both happen to me.  He discusses removal of strange foreign bodies from strange orifices, (been there).  He discusses the persistent fight with the bureaucracy of administration.  I quit insurance driven medicine for the same reasons.  The point where we split opinion is the contrast of the American and British systems and his hypocrisy in describing the British system of healthcare. 

He looks in some disdain on the American system.  While he acknowledges the advanced state of healthcare in the United States but he criticizes the privatization of the system.  He touts the “superior” distribution of healthcare in Great Britain as a public entity, but also constantly assails the big brother like intrusion of government in the minutia of delivery of care.  Some of his criticisms include: Poorly funded and understaffed hospitals, extremely long hours for NHS doctors resulting in broken homes and marriages, and the poor state of pay of NHS doctors compared to his friends not in medical service. 

Mr. Kay is a brilliant writer and comedian.  He is able to convey his emotions exquisitely through the written word.  I have no doubt that he was a special clinician as well.  That interpretation is made by the way he demonstrates his compassion in writing.  I think it would be an honor to know him personally.  Medicine lost a little of it’s heart and soul the moment he walked out of the field.