Watching 'This Is Going To Hurt'. A Doctor's View

**CONTAINS SPOILERS** In this episode I give my thoughts on the recent TV series based on the book "This is Going to Hurt" by Dr Adam Kay. In my opinion it was a masterpiece and will change the public perception of what a doctor does and has to go through.

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Chapters

• 0:00 Snippet
• 0:08 Intro music
• 0:50 This is going to hurt
• 8:30 Emotional patient experience
• 20:34 Final thoughts

Transcript

This is Going to Hurt and the hypocrisy of healthcare systems

Dr Polyvios: and the thought of admitting to their family, that they don't want to continue and letting down those who are so proud of them is too much for them to handle.

Welcome to doctors view with me. I'm Dr Polyvios,  join me as I discuss everyday topics in health and medicine and find the insights into everyday hospital life. Sit back and enjoy the show.

Hello, everyone. Welcome to a doctor's view. I'm dots. Bolivia's. If you're in the UK, you'll have no doubt heard of a recent TV series shown on the BBC called. This is going to hurt. It's a show based on a published diary of the same name and it's written by a junior doctor called Adam. It details the life, Virginia dot C in the NHS in a way that's never really been done before.

 And it takes the reader on a rollercoaster of emotions, includes joy and sadness and everything in between is a pastel of emotions that a doctor experiences on a very regular basis. A few months ago, the book was aired as a TV series. And as soon as I finished watching. Seven episodes of what was the most poignant thing I've ever seen on television?

 I knew I wanted to talk about it and just describe what I had just watched the. I had was I couldn't actually gather my thoughts about the emotional barrage that I literally just been bombarded with. And I couldn't actually watch more than two episodes at a time without needing to take a break for at least 24 hours, because it was just so intense and relatable.

And when I did actually finish the series, I couldn't sleep at least not. Well, I was trying to process everything I had just watched over the last week or so. It was a lot more difficult than I thought. So a quick word of warning before I continue, the rest of the podcast episode does contain some show spoilers.

So if your planning on watching this is going to hurt, please just save the podcast episode and come back to it after you've watched it and, uh, see what you think. So. The, the, the show has two main characters, Adam K of course. And Shruti Acharya who is the really junior doctor in the series that it starts with.

 Showing Dr. Shruti just really struggling to get to grips with this new found responsibility that she has. She's gone from a really, really junior doctor just graduated from medical school to just starting a specialty career in obstetrics and gynecology. And there's this [00:03:00] feeling of just being useless and just not being able to catch a break.

Everything you do is wrong. And that's basically because of. Inexperience. And in a way I initially got the wrong impression of the character. I was thinking, yep. This is quite inline with sometimes you get, you get a very junior people who. I have no interest in this. Haven't read up on the specialty that they're doing and, and all the things in between, you get a bad impression of them, but actually as the show goes on, you realize it's nothing to do with that.

 A more of the expectations and the responsibilities you have at that really junior level. And that feeling that you just can't catch a break. And the matter of what you do, no matter how hard you try things just don't seem to go your way and things always make. Bad. And this is something that a lot of us can relate to even the most experienced and best doctors that, you know, nowadays they've all been through that.

And it's something that we often forget. And this first episode actually did serve as a reminder of when I first started a specialty or when I first started medicine. It then goes on to show how everything that appears wonderful and shiny when VIP's and inspectors try and come and visit. And this happens, I think it's once a year or when the CQC come or once every so often.

And you notice that the hospital suddenly changes the bits of equipment that are in the, in the hallway or in the, in the, in the corridor or, or outside the theaters or wherever. And this is, this is every hospital I've ever worked in, by the way. Uh, they, they suddenly disappear because they shouldn't be there.

They should be sort of stuck away somewhere. Uh, because it shouldn't be loitering, the corridors and all this stuff  just vanishes. I have no idea where it goes, but it's, it just goes to show how, when the bureaucratic people come in, the sort of the shit reality of the situation actually just gets massed away.

And one story in particular, which is sad, that that is true. Is. When you're a trainee, you have to occasionally fill out audits to show that you're taking enough breaks during your shifts. And this is especially true for when you're a foundation, your doctor, an F1 F two, where you can go for quite a long time and realize you haven't had a break.

You haven't even had time to go for a week. And this is all that is to make sure that your leaving work on time, you are. Like I say, getting your lunch break, et cetera. And I remember a time where. No matter how hard you tried you, you wouldn't leave on time. Um, depending on the specialty you're in, especially, and I was working with some foundation, your doctors a few years ago, who were meant to finish around five, six o'clock in the evening.

And they end up finishing around nine, 10, sometimes in at night. And they were answering this audit accurately. They were saying when they were finishing. And you notice how all the seniors docs has always encouraged you to leave and make sure that you get home on time, always during this week when your, this all that's taking place.

Never, never before or after. Anyway, uh, so they were answering the, the audit accurately and they kept having to redo the audit because apparently they weren't doing it correctly. Even though they were answering it completely accurately. And it got to the point where they were asked to redo it so many times they got fed up of doing it.

So they end up just lying, uh, because, um, and just saying that they left on time just to be left alone. Um, This, unfortunately, I believe happens a lot. Um, I hope things have got a little bit better now. It's been a long time since I've been at that level and worked in, in such a difficult situation, but, um, I hope it's it's changed, but it just goes to show that the hostile do anything that they can, um, to cover up the fact that they're treating their staff like shit.

So there we go. Uh, The other things that are points down in the episode, um, early on is racist to patients. This is made apparent. I think it's the first episode, um, where, uh, Dr. Shruti is, is of Indian origin and the. Patient doesn't want to be treated by her. And that's random gets his own back, um, in his own way.

And unfortunately that comes to bite him back. And because you can't be rude to patients and no matter how much they may deserve it, um, [00:08:00] And it also shows that having a slightly Maverick attitude, when you're a doctor and getting your own back at the system and at patients in your own way, it might make you feel that little bit better and you may be doing it sometimes with the really best intentions, but ultimately to many, um, others who eventually take notice it can be grounds for a complaint.

And this is something that Adam found out when a close colleague reported him to the general medical council, uh, more on the GMC later. There's a really lovely side storyline, where Adam has a wonderful love, hate relationship with an elderly patient on the ward. She's very prickly with him and he gives as good as he gets, but they have this mutual respect for each other and she suddenly passed the work, passes away one day, uh, went and went out and finds out.

Deeply saddened. And he wanted to attend the funeral. Uh, and he was told to stop being ridiculous. Um, something similar actually happened to me in the very first year of qualifying as adult. I remember the patient's name. And we had daily chats when I'd go to take his blood. He was a lovely man and I met his family and they would visit him every, every day.

And every time I moved to a different specialty, when I was at point of when we were rotating rounds or different specialties at some point or another, he would always end up on the ward I was working on. Uh, he had. Problems bless him. And, um, he had this sadly, a failing body. And so every time my side news match the short enough that that organ, uh, would fail.

 Um, he would. Be there at some point. Um, I last saw him on the cardiology ward, where he had decided that he was going to stop taking his medications. Um, and he had made a decision not to prolong his suffering. His heart was failing and no amount of medicine was going to fix this. And even though I desperately wants them to continue his treatment, I felt deep down that he was actually doing the right thing.

He, you know, I told him. That this was my last day on the ward and that was moving to general surgery in the morning. And he shook my hand and looked me dead in the eye and just said, goodbye pool. And it was the first time I felt an overwhelming sadness for a patient. And I always check the records shortly after I left to see how he was doing.

And until a few days later, the words deceased. By his name. And I was very, very sad and it, it, it shows and it shows very well in, in the series, how you do develop these, these emotional attachments to people. You do develop relationships with, with patients in a, in a very unique way. And it's something that is unique to medicine and it.

Something that no matter how much you you read about and how much you feel, you have prepared for it. And to actually happens, it's something that nothing can prepare you for. And even no matter how experienced you are used to still get saddened, um, however, thick skin do you think you might be? So the show continues and Shruti is having a very, very bad time.

She. Slowly being bombarded with all the things in medicine and also outside of medicine. And she's trying to balance studying for exams with the stress of work being asked out for dates and, and she started to notice other things that are happening with patients. So there was one episode where she starts noticing the suffering, uh, of, uh, of a female patient who she believes is being abused by.

Uh, partner and she's initially being dismissed about it. And then she takes matters into her own hands and tries to make as much awareness as possible that this. Man is not a good person and is violently abusing his partner in the matter how much she denies it. She doesn't believe her. And it turns out that she was correct.

 Um, and all these things you can see that she's subtly, um, deteriorating, her mental health is going downhill and she. Crying for help in very subtle ways throughout the show and it's being dismissed and she's even asking for help in certain episodes for, to deal with certain things on the ward. And she's just being told to get on with it.

 And this is something I think anyone who's worked in the health service, I imagine all over the world, um, can relate to, to some extent [00:13:00] the. Next thing is we, we've spoken a lot on this show about burnout and disconnection from emotion. Um, and this has shown really well. There's an episode towards the end of the series where, um, Shruti.

Has clearly burns out. She is alone. She is struggling to deal with an insanely busy obstetric ward and labor ward. And she's covering, I think so many 20 or so patients and everything's going badly and she's got no support from any of her seniors. And you can tell she just doesn't care anymore. She does her job and she does it.

Brilliant. But she has no emotional connections. What she's doing, her facial expressions, her, um, the way she deals with the situation, she just couldn't care less. And this is a quite late sign of burnout, actually, when you have such a disconnection from your patients and from emotion, but it's, it's at that point now where.

Uh, it's, it's almost too late, um, because she's doesn't know what else to do. She just carries on with the shift and it's very, very sad to watch because you can, you can see it from a third person perspective. And it's sad that the colleagues on the wards that she was working on just couldn't really see it at the time.

Her parents are very, very proud of her. And this has made very evident in, in, in the show. And they're very proud that she is a doctor, very proud that she is delivering babies and saving lives and everything else that goes. Being a doctor on an obstetric ward and she is sitting her exams to further her career and to apply for a registrar [00:15:00] post.

And she's really struggling, as I said earlier, to try and balance the work and the exams and having to disappoint all these people to study. And when she finally passes her exams, she doesn't tell anyone, she just keeps it to herself. Because she knows that she's not going to continue. And there's this fear of disappointing everyone around her.

Uh, she eventually very sadly, um, commit suicide. Um, this has shown off screen as it were, uh, it's very heavily implied as the, as an episode ends. And it's made apparent as the. Last episode begins that she has tragically taken her own life. And it goes to show that there's this fear of disappointing everyone around you.

Um, the fear of disappointing her family, um, her friends, this thought that it's easier to take your own life than to leave medicine. Because of the disappointment is going to bring everyone around you and. It's really tragic. And before this episode, there was the final burnout episode, as a, as I said, and there was this way that everyone perceives private health care to be this incredible, wonderful thing.

Um, essentially a patient goes into private healthcare and Adam's actually taking a private shift there and something goes wrong and it shows that how ill-equipped the hospital. To deal with the situation. And the patient got transferred to the NHS hops with all that Shruti was actually working at, and she saved the life of this, of this mother and the baby, [00:17:00] and, uh, did so with a deadpan emotionless face, clearly showing that she had been burnt out at this very busy shift that she was on.

 Um, and that was a very poignant. Points, uh, because people do perceive private health care to be incredible and wonderful. And it is if you are this wonderful fit and well patients having a small procedure and nothing goes wrong and you pay them a lot of money for it. But in reality, it's often these private hospitals, they're very ill-equipped.

 They can't deal with serious complications. They don't take complicated patients for that reason. Um, and ultimately it will be the NHS that will save your life when things go wrong. If things go wrong. For me, the show was actually a masterpiece. Um, the, the entire series demonstrates so accurately just how broken the healthcare [00:18:00] system in the NHS really is.

 It shows the understaffing, it shows a lack of emotional support shows the mental stress involved in making difficult decisions and sometimes the wrong ones. And he then shows the guilt that the thought. Deal with when they do and the sheer inability to balance a professional and personal life. And the way that no one outside of work can actually relate to, they can't relate to what you're going through.

They can't understand why you're always letting them down, why you can't go to this party, why you can't go to this wedding. And, and there I say, it's sometimes why you can't go to a funeral. The difficulty in trying to maintain a relationship with someone. This is. Something, a lot of people can relate to.

And the inability to talk about the millions of problems that are just racing through your mind with anyone outside of health care. It's very hard for them to understand. And it often leads as shown in the show. A simple answer of it was fine. When someone close to you asks how your day was because you don't want to burden anyone else with your problems, let alone try and make them understand why their problems in the first place.

 The other poignant thing that the shows shows is that seniors can claim to be your support and savior, but are very willing to throw you under the bus faster than you could possibly imagine, just to try and save their own department or more often their own skin. Uh, this was made apparent in the show when.

Actually made a mistake and it results in a, a baby being, having to be born in emergency prematurely and ended up on the neonatal intensive care units. The consultants in charge said, don't worry, tell them that. I told you to send the patient home and it was my fault. [00:20:00] And he did write that in the notes and.

Actually, he then retracted this statement and, uh, basically made Adam take the blame for it. And this led to a load of stress and, um, they then tried to, he then tried to make Shruti who had recently died, the scape goats and, um, Did not do that. He, uh, stayed, maintained his integrity and, uh, stood in front of the GMC and gave them a piece of his mind.

And the fact that there are a growing number of doctors who tragedy take their own lives because they see no other way out as quitting equates to failure in their own minds and the thought of admitting to their family, that they don't want to continue and letting down those who are so proud of them.

Too much for them to handle, so yeah, I just also want to say, since I began this podcast two and a half years ago, nearly three years ago, now I've tried in my own way to portray the reality of life as a doctor, to provide an insight to those who are interested in what we do or indeed.

 Are interested in becoming a doctor one day. And I can honestly say that this is going to hurt the, the TV series is a game changer and I believe will forever change the perception of life as a doctor. Not only for the general public, but for aspiring medics too, because it's for the first time, something so accurate and truthful has been portrayed to an audience of millions in such a way that no one can actually escape from understanding the harsh reality of working as a doctor in the NHS it's been done in a way.

I never thought would be possible. So don't try them. K, the producers, the writers, and all involved in making the series. Thank you. And if you are a doctor or healthcare worker in the NHS and are struggling, feeling depressed, burnt out, or just don't know what to do, please reach out to the amazing people at doctors in distress and incredible charity, which helps doctors overcome the emotional impact of their work and provide.

 Mental wellbeing support through their facilitated peer support groups. Please don't suffer in silence. Please know that you are not alone and that there is a solution that you never thought possible. You just need to talk to people and these people can really help you. And with that, I'll leave you. If you are enjoying the show, please follow or subscribe.

 And as always, please look after yourself. I'm Dr Polyvios, goodbye.