In the Acknowledgements section of this book, British neurosurgeon Dr. Henry Marsh starts with this sentiment: “I hope that my patients and colleagues will forgive me for writing this book.” Why would this be? As a physician, I found his many stories of serious illness, tragic consequences of surgery, and ethical dilemmas profound and not unlike many American hospital stories of illness and suffering. However, as a layperson, I think that the most significant conclusion I would make from reading Dr. Marsh’s stories is that one should never have a neurosurgical procedure done. The brutal honesty of his thoughts and the mistakes that occurred during his surgeries can be quite eye opening and frightening.
The title of each chapter consists of a neurosurgical disease or a medical word, such as Aneurysm, Carcinoma, or Infarct, which sums up the main story and lesson of the section. We encounter an executive with a very rare pineal gland tumor whose surgery is delayed while a pathologist is in another part of the hospital. We also read the sad story of a woman in her forties with metastatic breast cancer whose family was not told of her grave condition after a brain biopsy.
Beyond patient cases, Dr. Marsh expounds upon the time consuming bureaucracy of medicine: finding empty hospital beds for sick patients to be admitted into, trying to remember a zillion passwords for the electronic medical record, and getting parking tickets by hospital security for coming in for emergency cases. We learn how the National Health Service (NHS), the single payer health care system in the U.K., discusses whether or not expensive treatments will be covered since Dr. Marsh sits on the panel that reviews scientific data and costs. We understand the frustration of what it must be like to be training the next generation of doctors under work-hour time constraints and how difficult it is to balance good patient care with teaching junior doctors complicated procedures.
Dr. Marsh’s own experience as a patient who undergoes retinal surgery and then also surgery for a broken leg illustrate the difficulties of being a patient who has too much knowledge of the medical system. He is brutally honest in his rantings on the shortcomings of hospitals and procedural mistakes. To his credit, he spends extraordinary effort traveling to the Ukraine to operate on patients with brain tumors that could not receive medical care in their home country. He even brings two patients to London for their surgeries, one being an impoverished twelve year old girl with an extremely large brain cancer.
Both inspiring and discouraging in its explicit descriptions of neurosurgical cases, Do No Harm will help the reader get a realistic view of many of the difficult issues in modern day medicine.