Review: Vivien Horler

Undoctored, by Adam Kay (Trapeze)

Around six years ago a British junior doctor, Adam Kay, wrote a hilarious, poignant and often angry memoir called This is Going to Hurt, based on his experiences with the National Health Service.

He finished the memoir with a letter to the British Health Minister, pointing out the NHS wasn’t made up of hospitals, pharmacies and GP surgeries as much as it was made up of the people who worked there.

And he issued a heartfelt plea: “Be the politician in a generation who changes the stuck record and treats them with an ounce of respect.”

That plea fell on deaf ears. As I write this – on January 5, 2024 – UK junior doctors are on a six-day strike, with their picket-line posters protesting they are overworked and under-paid.

On December 28, 2023, in the run-up to the strike, The Guardian newspaper published an article stating two out of three UK doctors were suffering from “moral distress” caused by “the enfeebled state of the National Health Service”.

It said many doctors claimed to have been psychologically damaged “by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs”.

The article quoted the leader of the British Medical Association, Professor Philip Banfield, saying the NHS was “impossibly overstretched”, had thousands of vacancies for doctors and had a quarter fewer doctors a head of population than Germany.

Junior doctors are defined as doctors who have completed medical training and have up to nine years’ hospital experience or five years’ as a GP.

This is Going to Hurt chronicled, in diary form, Kay’s NHS experiences from August 2004 to December 2010, when a particularly tragic Caesarean delivery led him to quit medicine.

To be fair, he had had misgivings about being a doctor from the start, but had more or less been shoehorned into medicine by his family who were almost all doctors. His school career had been conducted with the goal of getting into medical school, and when he did, he continued to follow family expectations.

He specialised in obstetrics and gynaecology, and a lot of the memoir manages to describe fairly eye-watering details in a way that will also have you chuckling out loud.

Here’s a sample: “When you reach a certain age, your body attempts to turn itself inside out via your vagina, but you can avoid all this by performing pelvic floor exercises. There are leaflets that describe these exercises in confusing detail, but I always just used to tell patients ‘Imagine you’re sitting in a bath full of eels, and you don’t want any of them getting in’.”

His ability to make people laugh led to a second career as a scriptwriter and comic, and he has now written Undoctored, a sequel to his first memoir. This second title is equally funny, devastatingly honest and still angry about the state of the NHS.

He further draws on his medical experiences in Undoctored, writing flashback chapters which interrupt the narrative of his new life, much of which is spent travelling around Britain to get to gigs. He receives a lot more affirmation from audiences than he ever did from his seniors in the medical profession, he points out, and is much less likely to kill anyone.

He is gay, married to a TV producer, and describes how he had to come out to his 80-something grandmother one Christmas, after his mother told him she wasn’t going to do his “dirty work” for him.

So he told her, in the car on their way to Christmas lunch, that he was now in a new relationship with J, who was a man. Grandma would meet him at lunch.

He braced himself for her reaction. “Oh, no, Adam. Oh dear,” she said. Kay’s heart sank. Then she added: “I haven’t bought him a present.”

He is enormously supportive of the work of the NHS and the coal-face people in it, but is scathing about the training of medical students who are taught to be emotionless.

He asks whether the NHS is choosing the right people to be doctors, and whether they are being trained the right way. “If the answer to both questions is no, then you have the chance to change the lives of a generation of doctors and, with them, a generation of patients.”

The book is a delight to read, but also contains a warning to us, to my mind. If the vast NHS is collapsing, one fears the implementation here of the government’s ambitious National Health Insurance scheme, given a variety of factors, not least the collapse of virtually every other state institution, and the high possibility that many expensively trained SA doctors will emigrate if plans to abolish private health come to fruition.

You’ll laugh out loud at parts of Undoctored, but will also be left feeling a trifle uneasy.