Doctor-turned-author Adam Kay: 'The best doctors are not the cleverest doctors'

While rheumatologist Eitan, the main character in Adam Kay’s latest novel, may share some character traits with the author, his chosen method of self-medication is not among them, Kay says.

“He's a bit more chaotic than me. An example of that is the fact that this guy, who's a consultant rheumatologist, uses an antihistamine nasal spray at work, except he's replaced the antihistamine with liquid cocaine.

“So, I can categorically say that I didn't do that. But then again, I did drink quite a lot of white wine, not at work, admittedly.”

Kay is a British TV writer, author, comedian, and former doctor. He abandoned his career in obstetrics and gynaecology after a traumatic day in the operating theatre.

His memoir This Is Going to Hurt mined the harsh and frequently funny realities of that world and was adapted into a BAFTA-winning TV series.

His latest work, A Particularly Nasty Case, is his first novel. It's a darkly comic mystery about a doctor who, along with his penchant for nasal stimulation, also has bipolar disorder.

Mental health problems are rife in the medical profession, Kay says, and it offers slender support to medics who are struggling.

“I thought I was the first doctor who'd ever cried in the locker room, who'd ever cried in the toilet. But the truth of it is that almost every doctor finds himself crying in that locker room.”

Writing candidly about the pressures and coping mechanisms among doctors in his first book provoked mixed reactions, he says.

“I got a lot of correspondence from junior doctors saying, 'until I read that bit in your book…' the fact that no one talks about it makes you feel very othered, like you're alone in struggling.

“I had a small amount of hate mail from doctors, maybe 10 or 12 of these emails in total from senior doctors saying, 'What did you think was going to happen?' 'Man up', 'Grow a pair' - all those lovely expressions.

“And that reminded me that dinosaurs do still walk the earth, even in a profession that is ostensibly a kind one.”

The diaries he kept as a doctor were a form of therapy while he was working in surgery, Kay says. He had no idea they would launch him on a new career path.

“When I left medicine, it wasn't this sort of big plan thing. It was a terrible day at work. And I had to step away because I didn't have the emotional exoskeleton to deal with what I'd been through.

“And it's almost like you've got loads of transferable skills as a doctor. And I was like, 'Okay, I'm sure I'll find something'. But it turns out that being able to do caesarean sections isn't particularly transferable if you don't want to work in a hospital.”

So, he took some time out to start writing.

“And 15 years later, I'm still on my few months out.”

The typical A-grade student doesn’t necessarily make the best doctor, he says.

“The best doctors are not the cleverest doctors. It's not a job about memorising biochemical pathways.

“It's essentially a job about communicating. And we need to have the best communicators, the people with the best rapport with the patients, the people who best represent the patients. And that's not what we're doing.”

He would absolutely “uproot” the way medics are recruited, he says.

“A friend of mine, he was previously a criminal lawyer, a state-funded criminal lawyer. The conditions and the pay were so appalling that he was just like, I need to try something else.

“So, he became a train driver. And as part of his application, he had to sit down with a psychologist. who basically asked the question, ‘if the worst happens and someone jumps out in front of your train, how are you going to be able to cope with it?’

“You get asked that question if you want to be a train driver or an astronaut, you get that if you want to be on Love Island or various other reality TV shows, you'll have to speak to a psychologist first. If you want to be a doctor, there's none of that.”

He admits to feeling some guilt about leaving the profession and says he hopes to return in some form.

“I absolutely will return in some capacity when I’ve reached my sell-by date as a writer, I’ve definitely done my last caesarean section, which people will be glad to hear, particularly if they’re pregnant.”

His advocacy for mental health support in the profession is an area he’d like to develop further, he says.

“I don’t think I’d be a good politician, I’m always quite confused by people who want to go into politics who think they’re the people who are so important they should run a country.

“But I’d love to do something in some capacity, whether it’s on the fringes, helping with policy or educating directly in the mental health space, and hopefully I’ve still got something to give.

“I actually don’t think healthcare should be run by politicians, I think it’s too important for that.”