The Food Medic - S3 EP12 - *CHRISTMAS SPECIAL* - Christmas in the NHS

Episode Date: December 19, 2019

Welcome back to a Christmas special episode of The Food Medic podcast! This week Dr Hazel is joined by former doctor, Adam Kay. Adam is now an ​award-winning comedian and writer for TV and film. His first book "This is Going to Hurt: Secret Diaries of a Junior Doctor" was a Sunday Times number one bestseller for over a year, breaking all records, and has sold over 1.5 million copies. His second book "Twas the Nightshift Before Christmas" was released in October 2019 and an instant Sunday times number 1 bestseller, making him the first author to have simultaneous number ones for hardback and paperback non-fiction titles. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and a very big welcome back to the Food Medic podcast for a Christmas special episode. I'm your host, Dr. Hazel Wallace. I'm an NHS doctor, registered associate nutritionist and founder of the Food Medic. Now, I am incredibly excited to share with you this week's guest. He is a former doctor who worked for many years in the NHS as a junior doctor in Ops and Gynae. He is now an award-winning comedian and writer for TV and film. His first book, This Is Going To Hurt, Secret Diaries of a Junior Doctor, was the Sunday Times number one bestseller for over a year, breaking all records and has sold over 1.5 million copies. It has been translated into 36 languages and is

winner of four national book awards including book of the year and will be a new major comedy drama for BBC2. His second book Twas the Night Shift Before Christmas was released in October of this year and was an instant Sunday Times number one bestseller, making him the first author to have simultaneous number ones for hardback and paperback nonfiction titles. Ladies and gentlemen, it is Dr. Adam Kay. Adam, welcome to the show. Thanks very much for having me. So, can we go back to the beginning? Obviously, lots of people have probably read your books, know who you are, and may have heard the story before.

But when and why did you decide to become a doctor in the beginning? I mean, that's a very good question. I decided too young. I think doctors have to make the decision too young to do that as a career I think America gets health get almost completely wrong I think it's you know it's disgraceful that people not just people hundreds of thousands of people go bankrupt because of medical bills but one thing they do get right is medicine's a postgraduate degree in the most part so you're in your early 20s you've had a bit of a chance to

look around at the world but in the UK it's an undergraduate degree for the most part and so you make the decision when you're choosing your A-levels when you're a teenager when you're when you're 16 basically and that's a bad age to decide to do anything really let alone you know what you want to do for the rest of your life and and so I don't think anyone is particularly informed in medicine you talk about informed consent and I don't think people are informed in that way at that age and there are things about medicine that are difficult it is the most wonderful job in the world but at the same time it does take its toll and that's that's something I didn't ever really think about. And I don't think it's very easy to think about at that age.

So the answer is really, I was a doctor because there were doctors in my family. I went to the sort of school that churns out lots of doctors and lawyers and that sort of thing. And in the absence of coming up with a better idea, something I was passionate about, something I loved, I was sort of on that, you know, on that sushi belt and ended up at medical school. Yeah. And where did you train? I trained in London at Imperial College. I went around postgraduate and I definitely agree. I think I thought I wanted to be a doctor, wasn't so sure, did medical sciences and then realised actually this is something I could do for the long run. But even after that, I was thinking, you know, like it's very different going to medical school

and then actually coming out and doing the job and working. Yes, nothing can prepare you for what the job actually is. But obviously it's possible to do it as postgraduate, you know, but I think you get a lot less help financially from the, you know, the council and things like that. So it becomes more expensive and becomes something that not everyone is able to do. And the medical schools are more geared up for undergrads. And I do think that changing that a bit would potentially decrease the you know the dropout from the profession because people know

what they're getting into. Yeah now you kept journals during your time as a doctor and that kind of forms the basis of your books was this something that you intended to do to kind of look back in the future was it something that you had to do as part of reflective practice or how did it come about at the time I don't really know what I thought I was doing in retrospect it was quite clearly my therapy looking for the light amongst the dark because much as prospective medics don't particularly think about the bad days at work medical schools don't talk about it when they're recruiting and it's not really even talked about during medical school so when you qualify as a doctor slightly strangely you don't really have like a toolbox of what to do with the you know with the bad days and the bad days do

outnumber the the good days i mean that's the nature of the the job sad stuff happens and my coping mechanism was was looking for the light amongst the dark writing things down i never thought that anyone would ever read them, hear them. I'd sort of occasionally dig them out to sort of upset guests at dinner parties and that sort of thing. But, I mean, you're obviously obliged to keep various types of records as a doctor. But more than that, I was writing down the silly stuff and the funny stuff and the disgusting stuff. Mostly the disgusting stuff, to be honest. Yeah.

So your books are obviously hilarious. And I think like a lot of people find a lot of like light and humor in reading things that are also quite, you know, it's a time of vulnerability for people as well. It makes the hospital like a little less scary maybe but you you also don't sugarcoat the job of a junior doctor and you are quite realistic in that this was my working conditions and this was the norm was that something really important to you when you were writing that was that was desperately important so the reason the book was published was, you'll remember a few years ago, the junior doctors ended up going on strike. And this was a big contract dispute.

And it was about working conditions which would impact on patient safety and the best interest of the patient ultimately. And the doctors were fighting because they thought that was unfair and unsafe. But the government, with their big loud voice, was saying the doctors were being greedy and they want more money. And that was, as someone who by that point had left the profession, was consuming the media from the outside, it was heartbreaking to hear this sort of misinformation.

And then the doctors lost the battle, lost the war. But I thought that next time round, because there's always a next time, if people knew more what it meant to be a doctor on the front line, that it would be laughable, the idea that the doctors were in it for the money, for the wrong reasons.

And I could have called the book, you know, a harrowing portrayal of life on the front line of the NHS, and it would have probably sold about 12 copies. So by publishing my diaries, I majored on the funny stuff. I mean, hopefully it is ultimately a funny book full of silly stories, but throughout that, there are also the ways it impacts on my life on every doctor's life and hopefully showing a a real picture I've not obviously I've not invented the genre of the medical memoir by

by a century but I didn't think when I was a doctor that there was any book out there that I could show to my friends and my family say you know this is what it's like and so I wanted show to my friends and my family and say, you know, this is what it's like. And so I wanted it to be, to show that side of things as well. Yeah. And I think it also portrays the parts that maybe not all doctors talk about at home. What has been the response from doctors who have read your book? Have they said that they've resonated with the experiences that you've had the response has been mind-blowing really really humbling ultimately the book ends with the story of why I why I left the profession and I worked on labour ward and by the time I left I was a senior registrar so one below consultant so out of hours I'd be the most senior person

on the ward usually and um and all you ever want as a laborer doctor is a healthy mum plus a healthy baby and it was one of these awful situations where I was the most senior person and we ended up with neither healthy mum nor healthy baby and I talk very frankly about my failure to cope with that and and ultimately how how it made me uh leave the leave the profession and what I realized after the book came out because it's very easy to contact an author you know social media means that you know you could dm any you know anyone you want and um and so i get a huge amount of correspondence from doctors and slightly depressingly i guess or maybe it's good in one way i hear from a lot of doctors telling me they thought they were the first person who'd ever

cried at work cried in the locker room the first person who ever thought they struggled because there's this culture amongst medics that says you're a bloody doctor and you bloody get on with it stiff upper lip stiff drink on your march and when you know that you're struggling it's very isolating it makes things an awful lot worse to think that you're the only one and everyone else is doing absolutely fine and I talk about that and lots of other doctors you know I left 10 years ago now lots of other doctors still clearly think that they're the only person with with emotions but so I'm I'm pleased to have sort of helped to change that record a bit and a lot of a lot of doctors have said that they're grateful that they've got something they can show their mates that say this is why I missed your 30th birthday party this is

why I missed your wedding this is why I missed your stag do because that's just part of the the job as you as you well know it has this has this huge effect on on real life yeah obviously you're you like really open your book about one experience that really led you to leave then just in the end but I think that was probably the kind of straw that broke the camel's back after multiple kind of injuries um so to speak do you think there's enough psychological support for doctors and how do you think we can change the culture because I think the culture is slightly changing and that's more reflective of the overall culture as a society we're a bit more open about our mental health and feelings and things like that but as a doctor who still works in the hospital I can tell you that things haven't really changed in that yes we acknowledge with posters and things

but what are we actively doing and I still think there's a stiff upper lip type vibe around the hospital where you know you go to a crash call something terrible happens and then you go back to work and you just kind of continue seeing your patients and yeah and that's the norm it is and it's changing a culture is the hardest thing of all particularly such an old and large organization like the nhs that's going to be a very big ship to steer but yeah i think the support is woeful they teach you in physics at school that every action has an equal and opposite reaction you didn't know wherever it was when you're doing medicine you know when something bad happened you're breaking

bad news to it to a family or something it's never equal for the doctor for the patient or the family it can never be of course but there's always an opposite reaction and it does take its toll and I think there's there's a lot of things that need to change I think it starts right at the bottom at recruiting medical students I think there needs to be an absolute honesty about what the job involves you know I think a book like mine should be should be required reading for anyone who wants to be a doctor not just for financial reasons i think it's um you know you need to know what the 360 of the job actually is at medical school they need to teach the tools to deal with this stuff there's evidence doctors use evidence you know every single minute of your working life in the hospital you're using evidence obviously your patients want you to use evidence you know every single minute of your working life in the hospital you're using

evidence obviously your patients want you to use evidence not just like whim and there's evidence about how to cope there's evidence for talking to people there's evidence for taking time out there's evidence for the mindfulness for religion of the actual bag there's evidence for tea there's all sorts of evidence and doctors for some reason ignore that a bit when it's about them so that needs to be taught and ultimately when you're in the job there needs to be a more robust setup and it's it's very easy to say this we're at a time where the nhs is more stretched than it has ever been and it's very easy to say oh yeah there needs to be more support if you're carrying two people's bleeps if you're doing two people's jobs three people's jobs if you're a you know a nurse who's on a ward that's got 50

staffing you know your first priority is going is always going to be to to keep keep the ship afloat really yeah but there need to be mechanisms so like if something hideous happens like like such as what i just talked about on labour ward you need to be offered time off i think there needs to be a protocol that every hospital should have someone that you can speak to but that's not going to change anytime soon and in the meantime there's something that every health care professional can do and there's also something that everyone who's not a health care professional can do if you're working in a clinical capacity, it's impossible to do the best for your patients,

look after your patients, if you're not looking after yourself. And I think there needs to be an acknowledgement that it's too big an emotional burden to look after on your own. Everyone needs to make sure they've got a shoulder they can cry on. Doctors always tend, when you go home, how was your day yeah fine but you need to to start opening up because you can't

look after it all on your own doctors need to look after their junior staff as well and their senior staff and their colleagues and just look out for the people who are who are struggling and you know take them for a bowl of pasta and check that everything's everything's all right but the thing that everyone can do everyone who is listening to this in the uk will know someone who works in the nhs a million and a half people work for the nhs you can be their support network you can be the person who keeps asking, how was your day? Who knows that even though the person says, yeah, fine, the answer is actually never just probably fine. And hopefully with all of that, it will change. And it does need to change. You asked me before about what I hear from doctors. I mostly have positive messages from doctors but I've had a bit of hate

mail not much but you know half a dozen seven or eight maybe from senior doctors telling me what did I think was going to happen and I need to man up lovely phrase and you know and I'm being histrionic and I need to grow a pair and so there is an issue there are dinosaurs out there who do think that what i'm talking about about looking after yourself about mental self care and well-being is irrelevant and that doctors are somehow superhuman and can have an infinite capacity to cope that's that's not the case and it does need to change yeah and i think like you just said it's kind of this old culture but i do feel like it's almost up to this the kind of the new generation of doctors coming through to demand more you know it's okay to cry it's okay if something terrible

happens and you need time off there's a huge crisis in the NHS, as you know, with recruitment and retention. How can you retain the staff if you're not looking after them? Yeah. If someone has some awful incident, there is, of course, a cost implication. That will be repaid a hundred times financially if you keep them in the profession it's short-sighted not to look after staff i am recently went to a conference that you spoke at it was uh like an acute and general medicine conference and one of the stages that you were on was actually a smaller stage but it was so packed up because there were so many doctors there standing and listening and

your talk was quite short but you were talking about this exact topic kind of that culture in medicine and how you should always have a shoulder to cry on and be someone's shoulder to cry on in work and when these things happen and I just looked around at other doctors standing beside me and so many of them had tears in their eyes. The woman behind me was crying, like really crying. And it was really sad to sit there and just think they just needed someone to say, it's okay that this is a really hard job and that it's like sometimes you just will have a bad day and you can talk to someone about it. Yeah, because it comes back to what we talked about

right at the start it's a decision that most people make when they're far too young yeah you're putting a random tick on a you know ucas form whatever when you're a teenager there's nothing special about you doctors do an amazing job of course they do but there is nothing innately special about them they don't have a some amazing emotional exoskeleton or buffer zone to cope with whatever's thrown at them they could have been an architect or a lawyer or a civil servant or an accountant and they just chose medicine not really knowing what the job was actually going to involve and you just need to remember that even though you wear a stethoscope you are still that 16 year old yeah okay so let's move on from kind of just talking from the depressing stuff you've worked six Christmases in the NHS

haven't you so six yeah so yeah I've worked seven years as a doctor and I spent six of those on labour water. And obviously in your new book Twas the Night Shift Before Christmas they kind of cover all of those Christmases. What is your most memorable Christmas working as a doctor? Oh wow yeah I did work a lot of Christmases. I probably worked more than most doctors for a couple of

reasons first of all I didn't have any kids don't have any kids and obviously doctors with a young family would get first dibs on that secondly I'm Jewishish Jewish enough that I have to work every Christmas apparently not Jewish enough that I could get Saturdays off so talk about persecution and but I worked a lot of Christmases on labour ward there were generally generally reasonably jolly occasions like on labour ward there were a lot of festive names so hollies and and robins that the babies get given and and i remember talking to the midwives about the names that have gone out of fashion like grace and gabriel and and things over the years and one of the older midwives said that noel used to be a very popular name given it at christmas but

seems to have fucked that um hospital's obviously very busy time at christmas labor ward never gets quiet but over on the the gynecology um side of things there's a lot more alcohol sloshing around at christmas and i think people do things egged on by eggnog and there's the thumping baseline of every doctor's job is objects in our offices that never goes away and i think there's a definite uptick in that over christmas from like i had a patient who put some fairy lights internally and uh and turned them on causing some some burns giving new meaning to the phrase i put the christmas lights up myself i've had a stuck fairies mistletoe contact allergies down there um had a had a patient who came in with bleeding after sex which as as you know as hopefully a lot of your listeners know is a potentially worrying symptom and should always seek attention for and and so I I saw them this patient down in A&E and

inside everything looks just a bit sort of grazed and there was like clearly a piece of the story missing like maybe her boyfriend was that big yellow bloke from the Fantastic Four who's made out of rock or something but um but as it turns out she'd um in in need of a condom and with with none immediately to hand they dipped into the the selection box and used a mars bar really embracing the play aspect of work rest and play and uh it was a weird one didn't need didn't need any stitching or anything i I just, um, advise them to use less abrasive modes of contraception in future until it's, until it's healed to take a break, but which I didn't mean, um, you know, use a Kit Kat wrapper. Oh my gosh. with their disgusting stories for you. Oh, here's on a food theme. And this is actually from New Year's Eve.

There was a patient who not needing a condom, but needing lubrication and not finding any, went to the kitchen for inspiration and returned to the bedroom with a tub of peanut butter, which actually isn't the worst choice in the world. It's oil-based, offers the choice of smooth or crunchy. But there are downsides to peanut butter, obviously. It'll make a mess.

It's an oil-based lubricant, very bad for condoms. And also some people are allergic to peanuts. For example, this patient. And on questioning her about why she why she did this she said she thought it was only a problem you know up the other end but her theory obviously was was it was incorrect and she avoided you know the worst case scenario but did it did cause lots of swelling she couldn't pass urine so and so she got cleaned up catheterized and it all sorted itself and out with medicine um and i advised her to not make any further use of intravaginal sun pat

what a memorable new year's eve for her although at least she didn't go into vaginal lactic shock that's not a thing is it i didn't learn that at med school um so at the end of your most recent book Towards the Night Shift Before Christmas kind of this is after your medical career and more recently and you almost say that you kind of miss being a doctor is that something that you get I do I do miss it and there's a lot that I that I don't miss but there's a huge amount that I do miss it. And there's a lot that I don't miss, but there's a huge amount that I do. And it sounds a bit pathetic, but the reason doctors do it is to help. And, you know, the arts obviously have huge value

and, you know, and I think the arts are very important, but it's a great number of steps away from working on a labour ward, delivering a baby, saving a mum's life whenever that happens. And I do miss that. I miss the fact that when you're driving home three hours late, covered in placenta, absolutely exhausted, winding down the window of the car just so you can stay awake, you've still got a smile on your face because of what your day actually involved at work.

And I miss that. And even at Christmas, I've got lots of doctors in my family. And I write about one Christmas where my sister was on a, just come off a night shift, working on a labour warden. My brother was going off to start his shift and uh and i was you know asking the questions oh to my sister oh what happened on the night oh yeah what happened with that patient and sort of went upstairs for for my uh my afternoon nap which i do on christmas day and i thoroughly encourage and uh my husband said to me

you miss it don't you so just from i i, I clearly can't shake it even at Christmas. You know, it's a very happy and rewarding place. Yeah. And on that note, would you mind reading a part of your book for me? I would not mind at all. 26th of December, 2004. Full marks to the anaesthetist wearing a badge that says he sees you when you're sleeping, he knows when you're awake.

22nd December 2006 Patient FJ is pushing. I'm on forceps duty and the radio is shitting out the Christmas classics. I have done my second pull accompanied by Johnny Mathis, the baby is nearly Out and we're all catching our breaths before the grand finale. The patient suddenly shouts out at the radio,

No Johnny, that is not what happens when a child is born. Thank you. Well thank you so much for chatting with me today. It's been so lovely to... Really enjoyed it. I it now almost awake yeah it's ready time to go to work time to get up um well merry christmas and to you