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This is going to hurt: secret diaries of a junior doctor
  1. Shamela de Silva
  1. Department of GU Medicine, West Middlesex Hospital, London, UK
  1. Correspondence to Dr Shamela de Silva, West Middlesex Hospital, London TW7 6AF, UK; shameladesilva{at}

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Adam Kay’s time in medicine may have been relatively brief, but it was filled with experiences familiar to many of us, and he has taken reflective practice to a different level as he revisits notes he made for his training portfolio. I thought that as a doctor who had worked through years in the National Health Service, familiarity would breed not quite contempt but indifference to this book. I was wrong; the author’s writing offers a fresh and insightful perspective on the familiar, chiming true with my own experiences, while bringing into focus emotions that we have too little time to acknowledge in clinical practice. He does so in an accessible way, without preaching or belittling, gently reminding us how ordinary clinical practice is extraordinary for those not familiar with a medical environment. It is also, on occasion, irrepressibly funny.

Monday 14 May 2007

’In the doctors’ mess, my friend Zac, currently working in orthopaedics, tells me that he always muddles the words ‘shoulder’ and ‘elbow’ in his mind, and has to really concentrate before using either term. Before I even have time to process this and what it could mean for his next patient, an intensive care registrar joins in from the next sofa: since childhood, she’s always malapropped the words ‘coma’ and ‘cocoon’. The more she tries to remember which is which, the more her mind convinces her she’s got it the wrong way round. She shows us a piece of paper in her wallet that reads,



This, we hear, helps prevent the admittedly hilarious scenario of sitting down an inconsolable relative to break the news that their husband is in a cocoon.'

I think medical students and doctors off all ages would enjoy this book, and it should perhaps be recommended reading for those considering a medical career. My non-medical friends reacted most strongly to it, surprised by how different the realities of clinical practice are from their own experiences. The popularity of Kay’s book may also explain why so many patients now ask if I am having a good day, as the books ends with the author reminding us that doctors are humans too!


  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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