#20BooksofSummer: This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay

'It [the NHS] will last as long as there are folk left with the faith to fight for it.' (Aneurin Bevan)

In 2004, after six years at Imperial College, Adam Kay started his practical medical training in a large London hospital.

In 2010, he gave up medicine.

Although one highly traumatic incident finally caused Kay to leave his career behind, the cumulative effects of six years of overwork, low pay, enforced risk-taking and stress must have played their part. This is Going to Hurt is made up of some of the diary entries he wrote in the few spare moments he had during those sleep-deprived years. It's hilariously funny. It's also a very sobering look at the state of the National Health Service, what it does to its employees, and what that says about successive governments' attitudes to healthcare.

Would-be doctors self-select at a very early age. By 16 they need to have chosen the right A-levels;

'on  a trajectory that continues until you either retire or die.. you're stuck with it.'

They then race to accumulate a stack of extra-curricular activities in an attempt to make their UCAS statement more impressive than anyone else's for, as Kay points out, vastly over-subscribed medical schools aren't interested in anyone's psychological suitability for the job, all they want to see is a list of sporting achievements and music certificates. Some applicants think they're going to cure cancer, some see themselves as the next George Clooney (ER - remember that?); Kay himself never really questioned his motivation - his Dad was a doctor, his school (Dulwich College) churned out fodder for the professional classes. Why not?

Then he graduated from university and arrived in the real world, one in which (very) junior doctors are left to cover an entire hospital at night while their only senior colleague stems the flow in A & E. One in which doctors run frantically from one urgent case to another, frequently have no idea what they're doing, never finish their shifts at the allotted time (or anything like it), and get paid £6.60 per hour (Kay's salary as a Senior House Officer in 2005) for the privilege.

After his first year, during which he experienced everything from drug overdoses to a degloving, Kay chose to specialise in obstetrics and gynaecology;

'I liked the fact that it was a blend of medicine and surgery - my house officer jobs had proved that I shouldn't really be majoring in either.'

The stories he tells about life on the labour wards and in the gynae clinics are often very, very entertaining. A hemorrhage that turns out to be less a matter of blood than of beetroot consumed the night before, a 'hermaphrodite' who turns out to be a haemophiliac ('the interpreter seems to be able to speak only slightly more Punjabi than someone who can speak no Punjabi whatsoever'), a Fireman Sam sponge found a very long way from Pontypandy...

Kay does not, however, shy away from the bad stuff. Having to confirm the death of a baby in the womb, talking to a woman who's just received a terminal diagnosis...doctors are expected to take all of this in their stride, with no training (at least in his day) as a counsellor, much less any counselling for themselves. Meanwhile they work such long hours that Kay falls asleep at the wheel, accidentally runs red lights, and sometimes doesn't bother to go home at all, just sleeping in his car for the few hours left to him between shifts. He's late for (or has to cancel altogether) numerous dates with his partner, one of his friends attempts to dump him for having to bale out of (amongst many other things...) his baby's Christening and he becomes accustomed to guessing what happend in the first half of shows. He misses funerals, weddings, stag weekends and parties so often that his friends would be surprised if he turned up.

Even when left alone to cope, junior doctors can - in theory - call in a consultant for assistance. Some of this rarified breed are supportive, understanding and do all they can to help. Others, especially those above a certain age, turn up only for ward rounds, private patients, and - as Kay discovers when wondering why a particularly absent colleague has suddenly materialised on the ward - television documentaries;

(cameras on): 'If you've got any problems at all during the night, just call me.'
(cameras off): 'Obviously, don't.'

I suppose the rationale for this behaviour must be that senior doctors were once the lowest of the low themselves, so they're now enjoying taking it out on the next generation while spending their time on the golf course, at the club, or admiring their vineyards in France.  There can be few other professions where such inexperienced junior staff are routinely lumbered with so much responsibility for decisions that really can be a matter of life or death. Surely historical precedent can't justify this practice? Yet on and on it goes.

Our NHS is a wonderful and precious institution, but the way it treats its staff would be unacceptable elsewhere. Junior doctors today are also subject to unprecedented demands and abuse from the public - Kay has to deal with patients who disagree with his diagnoses (Dr Google knows best...), think every delay is due solely to his bone idleness (he's usually dealing with three or four emergencies at once) - yet at one point he is summoned urgently, in the middle of the night, to someone who just wants her passport application countersigned.

Fifty years ago doctors were rarely sued, and although it is of course important that patients have recourse to legal remedy in cases of real malpractice, there are lawyers who are all too willing to encourage clients to submit unjustified complaints. Doctors today have this threat hanging over them at all times, so - like teachers and indeed lawyers themselves - they are required to keep extensive records of everything they do. No time is allocated for this record-keeping - it's yet another thing that Kay and his peers have to fit in (long) after their shifts have finished. Is it any wonder that doctors are leaving the NHS at unprecedented rates?

These are young people who have had to pass some of the most difficult exams in the UK and have then worked themselves into the ground trying to help people. For despite all the horrors, Kay always goes the extra mile to give patients the best service he possibly can; at the same time, outside work, he also supports a depressed and frequently suicidal friend. When he eventually leaves medicine it is not because he is fed up, exhausted or impoverished, though all of these apply. He leaves because he can't get over the dreadful outcome of a particularly distressing case - an outcome that is not his fault and for which he is blamed by neither the patient nor the General Medical Council.

'One brilliant consultant tells her trainees that by the time they retire.... a huge number of 'adverse outcomes' will have occurred on their watch...if they can't deal with that they're in the wrong profession. Maybe if someone had said that to me a bit earlier I'd have thought twice.'

In recent months the NHS has faced a challenge like no other. Its staff have risen to that challenge; of course they have. For this and for all their work and dedication they deserve more than clapping and cheap meal vouchers. At the end of this book Kay writes an open letter to the Secretary of State for Health, suggesting that all such politicians should have to work some shifts alongside junior doctors;

'The NHS...is made up of the people who work there. Be the politician in a generation who changes the stuck record and treats them with an ounce of respect.'

Three years after Adam Kay wrote those words, it seems to me that we are no nearer reaching what really should be an unambitious goal.

This is Going to Hurt by Adam Kay is published by Picador, an imprint of Pan Macmillan.
Dear NHS: 100 Stories to Say Thank You, edited by Adam Kay and published by Hachette UK, is also out now.