The following version of this book was used to create the guide: Kay, Adam. This Is Going to Hurt. Picador, 2017.

Adam Kay opens This Is Going to Hurt by discussing his process of becoming a doctor. He talks about how the process is relatively arbitrary for students who make the decision at sixteen to pursue medicine, and also how schools care about meaningless activities when evaluating students for entry rather than qualities that show possible success in the medical field. At the end of medical school, Kay remarks that, in retrospect, he was completely unprepared to enter into his new position as a house officer. During Kay’s time as a house officer, he witnessed his first death, saved his first life and claims that he has practically acquired PTSD as a result of the work (18). The reader also sees some of the first examples of the inequities of the NHS, including long working hours and lack of appreciation.

In his first post as senior house officer, Kay jokes that there is no raise in pay, despite the raise in title, and that it is probably just to “give patients a bit of confidence” in the doctor (30). Kay decides to specialize in obstetrics and gynecology. During this post, Kay wakes up to Christmas morning on the labour ward after falling asleep in his car, humorously highlighting that he and H will celebrate Christmas on his next day off, January sixth. Kay also begins a relationship with Simon, a school friend’s younger brother, who has written a suicidal message on Facebook, telling him that he can talk to Kay about the situation.

In his second post, Kay writes that his new hospital has much less guidance for doctors than his previous ward, and that much of the work follows “see one, do one, teach one” (63). In this chapter, Kay explores the unfair nature of having to pay and take exams along with arranging his own replacement for sick days.

Kay opens his third post as a senior house officer by discussing the claim that doctors are “profoundly underpaid” (86). Although there is more responsibility as one progresses as a doctor, there is minimal pay raises. Kay argues that while one gets used to the lack of financial incentives, it is much harder to come to terms with the lack of praise. During this post, Kay is looking for an apartment with H, which exposes the financial relatives of being a doctor and the strain his job puts on his relationship.

On his first post as a registrar, Kay tells the reader that this increase in title means an increase in responsibility with the expectation that he be “unimpeachably correct and clever” (108). Although Kay is feeling optimistic about the position, he tells the reader that many of his colleagues are not so luck, as they experience strain on their relationships as a result of the difficult working hours and stress. During this post, Kay has to deal with multiple infant deaths and he struggles with these difficult parts of the job.

In his second post as a registrar, Kay tells the reader that he has always been proud to say that he worked for the NHS, and he warns his audience about the negative side to private healthcare. As an example, he writes about a consultant who refuses to let Kay deliver “his patient” (141). The reader also sees Kay have a good relationship with Mr. Lockhart, his consultant, who gifts him a Montblanc pen at the end of his position at the hospital.

Beginning his third post as a registrar, Kay writes about how he is trying to determine his bedside manner after receiving a letter informing him that he was being sued for medical negligence. Kay also visits his friend Ron’s dad after he has been diagnosed with cancer, and is pleased to see that his personality has not changed.

During his final post as a registrar, Kay confesses to the reader that his “resolve wavered” (196). However, he admits that while there are loads of problems with the job, “there’s no better job in the world” (198). During this post, the reader sees Kay explore the implications of his severe lack of sleep, attributing this to the ridiculously long working hours. This includes not having time to see his friend Ron who tries to dump Kay as a friend.

While on his last post as senior registrar, Kay says that although he has thought about leaving the job many times, he is still there. During this post, Kay has to deal with the complicated criteria for the infertility clinic and reflects on the unfairness of the system’s criteria. He also accidentally cuts the cheek of a baby. Worst of all, he experiences a horrible caesarean gone wrong, losing the baby and suggesting that the mother will die as well. This was the last diary entry Kay wrote, and he ends the book detailing his leave from medicine. The incident clearly scarred him and he had trouble returning to work. Kay concludes with discussing the “exodus from medicine” that many of his colleagues similarly experienced (261). Kay asks the reader to leave with thinking more about the NHS and how it negatively impacts medical professionals.