A darkly humourous portrayal of a life in medicine

BBC’s new drama, ‘This Is Going to Hurt’, is required viewing for medical students and trainees 

Anyone I have met recently has had to endure my exhorting them to watch the new BBC drama This Is Going To Hurt, based upon the book of the same name by Adam Kay. Written by a former NHS obstetrics and gynaecology trainee, it is a hilarious but affecting memoir of his experiences before tragic events led him to leave clinical practice. The book came out when I was an intern and was a huge overnight success; it immediately became our generation’s The House of God. Like The House of God, those not in the field accused it of being hyperbolic and derogatory to patients whereas those within could only remark on how true to life it all was. 

Descriptions like “You’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail” perfectly embodied that overwhelming terror of your first set of intern nights. Kay’s descriptions of his training years encapsulated the sheer exhaustion of having to drive home after a 26-hour shift and enduring a blistering post-call ward round that was akin to being cross examined in court when you were past the point of even being able to speak. 

It does strike me that such a TV show or book could only be written by someone who has left medicine 

Although the television show is genuinely laugh-out-loud funny, it has serious topics at its core. I truly believe it should be required viewing for all medical students and trainees as it explores themes, such as trying to keep your work-life balance even remotely on an even keel and dealing with mistakes when they have serious consequences for your patients. It even covers the dread and trauma of being called in front of the Medical Council, which surely must be one of every doctor’s greatest fears. Without too many spoilers, the show does go to a much darker place than even the book and covers topics such as doctors’ mental health, burnout, and all the warning signs that are missed and ignored until it’s too late. After the last two years, burnout amongst Irish doctors is a greater issue than it ever was before. A recent study carried out by the IMO found that 77 per cent of training doctors reported symptoms of burnout and that 96 per cent of all doctors reported that challenges of staffing and workload negatively affect how they treat their patients. 

Praise for both the show and the book have not been uniform, however. It has recently met with accusations of reflecting the misogyny that can be found within healthcare settings. Referring to the specialty as ‘brats and twats’, it is fair to say that the patients are indeed a secondary concern at times to the protagonist. These accusations were something that did not initially occur to me, as a ‘woke’ millennial who thought I was attuned to sexism in all its forms. Yet, as someone who has briefly worked in, but has not had to personally use, gynaecology or maternity services it was something I really had to ponder and sit with. It is still my view that although it was written by an obstetrics trainee, the same themes could have been written by a surgical or medical trainee or anyone in healthcare that has been broken by the system. Medicine is known for its black humour and I do think if the public heard how doctors can talk about patients on occasion they would be horrified. The character as written for TV is not an admirable figure. His approach to medical ethics and basic human decency is deeply skewed and not to be emulated. It is well known that high levels of burnout lead to depersonalisation and lack of empathy. There was zero focus on the patients, but it can be argued that that’s what happens when people in a bad system are doing whatever they can to survive. 

It does strike me that such a TV show or book could only be written by someone who has left medicine. Such levels of honesty, even wrapped in humour, from someone in the early stages of their profession would likely be career-ending. However, it is crucial that people continue to speak out about dangerous working environments for both patients and staff at a time when exhaustion and burnout is at an all-time high. Good people are continuing to leave specialties and medicine at times when they are needed most. Poor mental health and suicide in training doctors and medical students are still happening and that is not a laughing matter. 

Watch the trailer here: https://www.youtube.com/watch?v=v4h8xbc0cPg