Friday, 14 August 2015

Do No Harm


Just finishing 'Do No Harm' a series of case studies by the London neurosurgeon Henry Marsh. The book was recommended by a neurology colleague and friend of mine. Thank you.

The book is a remarkably frank account of what it takes to be a neurosurgeon; warts and all. It also highlights many issues we all have on a daily basis with the modern NHS. It is the first book I have read like this from a surgical perspective; there are many penned by neurologists. What the book highlights are the obvious cultural differences between neurosurgeons and neurologists. Neurosurgeons get immediate results, good and bad, and have to face their demons on a daily basis. Neurologists rarely get such acute feedback, which may explain why there is such a wide variation in our practice; particularly when it comes to adopting new therapeutic practices. The latter makes the quality metrics I have been discussing on this blog so pertinent. And yes we, the ABN, did get our response in on time to NICE.

Enough said 'Do No Harm' is a brilliant read; another high recommendation.  In fact I am going to make it an essential read for all my trainees.


  1. There's a BBC documentary The English Surgeon featuring Dr Henry Marsh. He read politics, philosophy and economics before studying medicine.

  2. Glad you are having a good holiday. Heard you 'speak' for the first time on youtube the other day after reading this blog for several years now, looking forward to reading and hearing more in the years to come.

  3. There is also God's Hotel, about a doctor's work in admissions at Laguna Honda long term care hospital in San Francisco. The doctor's description of finding diagnoses where the County hospital had not, put the differentiating factor squarely on having more time to spend with patients. One of these was a large cancer on an indigent patient's back. The doctor/ author also describes how the nurses once had time to watch for and notice/ respond to emergencies, but more recently that time was filled with required duties as staff levels were cut.

    The lack of time by GPs and ED doctors delays ms diagnosis among others. At least in the US, with the corporate takeover of much of health care, consolidation of independant practices into hospital owned groups, the time available is still shrinking. We could bring back routine autopsies to document how many diagnoses are being missed, but I doubt we will.

    God's Hotel is a beautifully written tribute to the hospital, a thoughtful exploration of what factors facilitate vs impede healing and care, and a plea for a return of space and time to the practice of medicine.

  4. What I find interesting is during a recorded interview of Henry Marsh he mentioned that if the general public became more knowledegable about health/medicine it would help (society). I've been thinking about this and since being diagnosed with MS I have an interest in medicine including basic family health care and first aid, also preventive healthcare. Although I understand conditions such as MS there is not yet a definite known cause.
    Perhaps basic healthcare could be taught in schools, covering wellbeing and healthy living such as diet. Also getting the best from the NHS without causing a burden. May be this will bring debates about a nanny state.


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