Agnes Arnold-Forster | Carbolic Soap Operas · LRB 8 March 2022

The BBC TV series This is Going to Hurt follows a junior doctor, training in obstetrics and gynaecology, as he struggles to cope with his chaotic NHS job. The programme is written by the doctor-turned-comedian Adam Kay, based on his bestselling memoir of the same name.

The book, published in 2017, was more funny than miserable, but the television version, though in many ways a faithful adaptation, is the reverse. The suffering on screen is unyielding. Kay, played by Ben Whishaw, isn’t entirely unsympathetic – racked with guilt over his medical errors and misjudgments, he at least tries to rectify the damage he does to his colleagues, boyfriend, family and friends – but he is very hard to like.

An unlikable doctor is a refreshing addition to the roster of fictional healthcare professionals who have appeared in Britain since the Second World War. Shortly after the foundation of the NHS in 1948, stories set in hospitals became more prominent. From Mills & Boon’s doctor-nurse romances to television series like Emergency Ward 10, the first of many ‘carbolic soap operas’, these were implicit, and sometimes explicit, bits of NHS PR, with idealised heroes and heroines – healthcare professionals who were beyond reproach.

In 1958, the managing editor of a widely read women’s magazine rejected a romantic novel for serialisation by arguing: ‘I have a theory that fiction must never disturb the faith and trust a woman feels for doctors and/or nurses.’ He was not alone in his concern that fictional representations of healthcare professionals had the capacity to undo readers’ and viewers’ devotion to the health service and its employees.

Since then, TV shows set in hospitals have become grittier (Casualty, Holby City). But, with some notable exceptions, the healthcare professionals were still portrayed as motivated by a higher calling, and programmes continued to exalt medicine as a noble cause. One of the exceptions was the sitcom Green Wing. This is Going to Hurt is like Green Wing in some ways, but because it’s much more realistic, and a lot less funny, it’s also harsher, more unrelenting. Kay treats a junior trainee, Shruti, abominably. Patients suffer because of his vengeful treatment and callous lack of interest. He speaks to and about the women he’s supposed to be looking after with cruel disregard, mocking their pain, humiliation and occasional ignorance.

Amid all the cruelty, it becomes clear that the real villain is the NHS itself. At its worst, the health service is a brutalising regime that strips its staff and patients of their humanity. This is in stark contrast to the more common portrayal of the NHS as a benevolent force for good. It can be – and is – both at once. Even before the pandemic, healthcare staff suffered disproportionate emotional harms. Mental ill-health, bullying and harassment among the NHS workforce was and remains rife. Female patients, and female patients of colour in particular, report that doctors are routinely paternalistic, patronising and even abusive. This is not true of every healthcare professional in the NHS, nor is it an accurate portrayal of every hospital, but as the NHS’s own research shows, it is also neither rare nor anecdotal.

The NHS is often dehumanising for those who work in it. There are fundamental problems with the way it functions, and cruelty is a cultural currency that steadily grinds people down. For anyone outside the medical profession, the language that staff use to communicate with one another in the series may seem abrupt at best, abusive at worst. Healthcare is a deeply hierarchical institution, and while there have been admirable efforts to disrupt the hierarchy, the apprenticeship style of training, coupled with a persistent belief in the value of unhampered authority in clinical settings, makes for a system that frequently shelters bullies from reproach or professional consequence.

This is Going to Hurt, the book, is one of many medical memoirs published in the last decade or so that claim to be no-holds-barred accounts of life in the NHS. But they are usually written by doctors, about doctors. Patients’ memoirs tend to have less success. Doctors’ memoirs also often mine the experiences of their patients without giving much thought to the interiority of those they treat.

This is Going to Hurt, the TV series, doesn’t spend much time considering the experiences of patients either. The programme focuses claustrophobically on Kay. The lives and deaths of female patients are used to tell a story about NHS staff and their collective trauma. It is an intimate, and horrifying, view of a health service from the inside out. Viewers are taken behind the operating theatre curtain, into the private spaces of the hospital. This vantage point makes it seem as though the NHS and its problems are principally about its workforce.

Kay wrote This is Going to Hurt during the junior doctors’ contract disputes with the NHS in 2015, and while the book was often crass, playing the misfortunes of patients for laughs, he intended it as a political act. He wanted to reveal the experiences of healthcare staff and the structural problems in the service. The TV version may yet serve a similar purpose. We’re going to have to wait, however, for a series that does the same political work for patients: that doesn’t only tell stories of healthcare professionals’ pain, important though they are, but foregrounds patients’ suffering instead.

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