This is going to hurt

One of the joys of having a Christmas/New Year break is having the time and space to read. I recently read a book called: “This is Going to Hurt: Secret Diaries of a Junior Doctor” by Adam Kay, based on reflections written while he was training in obstetrics and gynaecology. It’s a great book, and well worth reading, at times hilarious, at other times harrowing, but this is not a book review so much as a reflection on what his reflections brought up for me, as a senior doctor who now trains junior doctors and who, many years ago, used to be a junior doctor in a system as dysfunctional as the NHS is still revealed to be in this book.

It is actually a very painful read, as well as very funny, as it exposes the fact that the medical training system has not only not changed for the better since the days of my training, but is actually getting worse. I didn’t think this would be possible, but apparently it is.

The way our junior doctors are treated is still lacking in care, respect, understanding and appreciation and this, to me, is insane. These are the people who look after us when we are ill, these are the people who will go through the ranks (if they survive) to become battle-hardened to the point where if they make it out the other end alive (which many do not) they will often be hard, cynical, and now as care-less as the system that trained them, when they did not start off that way. And they then become the doctors who are in charge of training all the other doctors to come, passing on the attitude of: ‘If I had to do it, you have to do it too’.

We are teaching doctors to care for other people, but in the process we do not care for them as people at all. We do not even warn or inform them that: ‘This is going to hurt’ when it comes to training and working as a doctor. And then we act surprised when they behave badly, make mistakes, or kill themselves.

We do not tolerate this horrific training system in any other area of work that I am aware of. Even the army, which trains people to kill other people, takes better care of its own. Medicine forces us to endure conditions which no human can, and when we fail to somehow (no training provided) become super-human to meet its demands, it spits us out with little thought or care and lays the blame solely at our feet.

Spoiler alert: Adam Kay left the medical system near the end of his training. At the time he was an anomaly, but this is becoming increasingly common, leaving already over-stretched staff to pick up the slack. Either that, or people suicide, which also leaves those left behind with an increased workload, as well as the devastation of losing someone they love, as medical administrators continue to fail to fill the gaps created and fail to offer care to those who are left bereaved.

How is this sustainable?

When and where is it all going to end?

People are getting sicker, at an earlier age, with complex illnesses that require treatment from multiple specialists, and they are living longer, which means the complex illnesses and their various treatments compound. And once you get in the front door of any hospital, we now have to do everything we can to keep you alive, no matter what the quality of that life is, for fear of being sued, charged with a criminal offence, and or struck off the medical register.

So the personal and collective workload, intensity and stress is increasing, not decreasing, and the system is already strained to breaking point, if not already completely broken.

I recently went to a meeting at my local hospital where some surgeons were told that they were no longer allowed to submit Recommendation For Admission forms for patients who needed surgery, as their waiting lists were already too long and the hospital could not meet its targets. No care for people in this decision at all. No common sense either.

But this is what we do. Build bigger and fancier hospitals, fill them with more and more administrators, who get bonuses for coming in under an impossibly inadequate budget (or at least get to keep their jobs) and then making the working conditions of front line staff so intolerable that they leave, get sick or die themselves, while people are denied the care they deserve.

It is all about damage control, containment of fires that are burning out of control, and we are focusing all our attention and resources on the expensive end of the line, rather than looking at who and what is starting the fires and why.

Yet no time, money or thought is being put into simple, effective and cost-effective measures to improve quality of life and prevent serious illness.

Little to nothing is being invested in caring for people from a young age in the community and supporting families to raise healthy, happy children who love and appreciate themselves and enjoy life and don’t need to resort to overeating, eating junk food, drinking alcohol, taking drugs, checking out on screens, self-harm, dangerous sex, risky pastimes and all the other things we do to distract ourselves from our empty and unhappy lives and which get us into trouble and sooner or later into the door of a hospital.

We have come to the point where 95% of us are ill and 95% of those illnesses are lifestyle-related.

When are we going to let the truth of this sink in and start doing something sensible about it?

Do we honestly think our lives are going to be worse if we stop smoking, drinking alcohol, taking other drugs, eating too much junk food, spending hours on screens, doing no exercise and partying till late?

They won’t. They don’t. In fact, life gets far, far better and you start feeling more and more lovely and start once again enjoying being in your body and living your life. You have more energy, naturally, you feel better about yourself, you don’t have so many mood swings, you don’t feel so emotional and reactive, you feel more settled and steady in yourself, and you actually start to love yourself and your life.

Yes, this is going to hurt to begin with, as you gradually withdraw the props that have kept you going, and start to feel the state you are actually in, but this will be a short term pain for a long term gain … that is well worth every moment, every choice, every movement to be more loving and caring with yourself … and in the end, you will care so much about yourself that you cannot help but care for all those around you, whom you see and feel as your equals … and your living way may inspire them to care for themselves too … now that is great medicine, and it starts with us.

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This article was first published on 3 January 2020 on To Medicine with Love


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