This Is Going to Hurt

[Wouldloveanother]

I read this book a while ago but just re-skimmed it while bedridden with pregnancy sickness. I’d forgotten how funny it is, although the ending is tragic and poignant. I thought it gave a really good insight into the pressures on maternity staff and why it’s not always realistic for us to have the exact care we want in labour. I think it’s a shame he left medicine, but can see how he lost his nerve and didn’t feel able to go back. Anyone else read it?

He comes across as a massive disrespectful misogynist.

@Wouldloveanother yes but men aren’t routinely fobbed off, told its in their heads and denied care the same way as women are. Men don’t give birth so aren’t ever as vulnerable as a birthing woman is.

It’s apples and oranges.

Brilliant show, and pretty accurate too.

Another good show I can recommend is Bodies, available on Netflix.

Both shows perfectly depict the toxic culture in the NHS.

Midwives aren’t doctors. They don’t carry the same weight of responsibility and aren’t at the helm of the ship in life-or-death theatre situations. So it’s probably easier for them to seem more accommodating and personable to patients, they’re not under the same pressure.

But there is the power dynamics at play- a joke at the dads expense in the delivery room is not as cruel as mocking an unclothed vulnerable woman who is in pain.

I remember one excerpt where the joke was a labouring woman who was feeling extremely anxious and frightened about pooing when pushing, the ‘punchline’ was that her anxiety and lack of dignity was even more hilarious because she’d eaten a ‘massive curry’ the night before. I just don’t get how that is funny when it is being told from the perspective of a man who never has to be in that vulnerable position. Just nasty and cruel.

Thats nothing to do with the book though.

Absolutely this.

Another passage where he rolls his eyes at the concept of informed choice and confidently says that obs&gynae patients (so basically female patients) prefer the doctor to just make a decision and tell them that ‘this is what will happen’ rather than having patient choice. He jokes that ‘patient choice’ should be a case of- ‘This is what we will do, it is your choice whether to take it or have nothing’

This is very outdated now when you think of the Montgomery case and the rights of women to be the autonomous decision-makers in their own care.

Yep.

This specific show was in OB/GYN setting, but it could’ve been in any other speciality. Stakes are higher in maternity units, which makes it a good drama.

Going through the road of being a junior doctor all the way up to consultancy is quite a unique experience, especially in the UK. And the events described in Kay’s book took place around 2006? It’s probably gotten worse since then.

It’s certainly not for any viewer. Some people should stick to Gray’s Anatomy.

I agree. He was very frank about his own shortcomings, how he didn’t feel up to the job, the mistakes he made when caring for people.

There were some very touching parts, such as the lady with ovarian cancer and the elderly lady he visited regularly as she was dying without too many visitors.

I disagree with PP about him ‘fobbing off’ women. He went against a consultant’s instructions to discharge a woman because he felt something was wrong, turns out she had a ruptured ectopic.

OP there's some examples here

unherd.com/2022/02/adam-kays-dangerous-misogyny/

it's clearly a matter of taste but I can't see the "humour" as anything other than misogynistic.

I’m glad the book is so successful, I think it really illustrates the horror of working within the NHS, the trauma faced by our junior doctors who are doing something so important and should be looked after.

But I can’t forgive some of the portraits of patients. The bit where he has to hold the umbilical cord inside a woman whose labour is going pear shaped and plays it for laughs - he has to ‘wear her like a puppet’ - horrible.

@EmmaH2022 thats the thing with this book once you’ve seen the misogyny you can’t unsee it. Regardless of what arguments you read in its favour (and I’ve read many)

Thankfully it does seem to work the other way round with readers who don’t initially have a problem then realise just how sexist the book is

I didn't get any sense that Kay is misogynist. I think in many respects the point he was making is that working in that system beats you down and dehumanises you, so that you begin to view all patients as objects. Because all or most of his patients were inevitably women it looks as if it is directed at them, but he would have behaved in exactly the same way with male patients.

God it's awful, even the title makes me so angry, like thank you Mr important doctor for letting us know it's going to hurt. There is such a nasty misogynistic tone to the way he speaks about women's health issues that really got under my skin (and about all his patients in general). Really classic male saviour doctors view on childbirth and labour...urgh I can't stand it!!

As far as I know (correct me if I’m wrong) women would never be held accountable for insisting upon the wrong procedure if it resulted in harm to their baby or themselves. If they absolutely refused a c-section, and the baby died, they wouldn’t be prosecuted for that, nor would they be held professionally responsible.

A doctor would however. The buck stops with them and they take ultimate responsibility for whatever the outcome is.

So I do understand where he is coming from - this is what I recommend, why should I take responsibility for what I know to be the wrong decision?

I mean he wrote and performed a song about babies with down syndrome and a song about 'northern birds'- all for a laugh of course so the really offensive lyrics are fine naturally. You can tell what kind of person he is from the fact he found that acceptable- thank goodness he left working with vulnerable women.

It certainly gave me pause for thought in terms of how people complain about doctor’s actions, and that maybe there are good reasons behind it.

For example the part where he has to leave a c-section patient lying on a table with a compress over her uterus to run to another emergency. I can imagine a patient telling this story as ‘I was left on the operating table while the surgeon vanished for 20 minutes, I’m furious’ whereas he literally didn’t have a choice.

Brats and twats?

Not for me.

Oh, I thought that was funny!

So I do understand where he is coming from - this is what I recommend, why should I take responsibility for what I know to be the wrong decision?

If a woman is advised to have a section and refuses, and as a result has a poor outcome, the doctor won’t be accountable for that. They gave the advice, and aren’t responsible for the patient refusing to take it.

On misogyny, its not misogyny in the sense of he likes men but not women or anything like that. But he mocks and belittles the experiences, anatomy and injuries of those who are giving/have given birth. Given this only applies to women, it’s misogynistic.

laughing about prolapses doesn’t really apply to men in the same way.

Well he's completely killed that line of "don't worry, doctors have seen it all. They won't judge you."

I don't feel vulnerable going to see my GP about a sore throat but I do worry before an appointment in Obs and gynae. It is the very worst place for a man like him and this has only made my nervousness worse.

Really? Well, there you go.

i enjoyed the book mostly
the tv show was excellent - so well done. big ben wishaw fan anyway

A lot of HCP have dark humour and banter it's not really done outside the staff room or the office. It's probably a shock to the general public hearing it.