There are few people who know the human brain as well as British neurosurgeon Henry Marsh, but even he says the wonder and mystery of the tissue inside our heads still fills him with a sense of awe. As a senior consultant at St George's Hospital in London for nearly 40 years, he is the first to admit he made mistakes and he writes candidly about them in his new memoir, Do No Harm: Stories of Life, Death and Brain Surgery. He tells Afternoons with Simon Mercep “I felt it’s time to burst the myth of medical invulnerability”. Marsh says we need to be realistic about the limits of health care. “When you are a patient you want to think your doctor is a God who will never make mistakes and as doctors will feel obliged to pander to this wish of patients to be reassured and treated like children” says Marsh.
Over the years, Marsh says he operated on tens of thousands of patients and his mistakes were not about having steady hands or the mechanical aspects of surgery, but rather mistakes of judgment. “When I’ve made mistakes it’s usually about decision making. Decision making is all about whether you are honest with yourself: if you are on the ball or distracted” he says. The issue is often recognizing the mistake. “When you are a young doctor you have to pretend to a greater degree of knowledge and competence than you really have because patients don’t like young doctors who say I don’t know what I’m doing.” Marsh explains. And he says you end up deceiving yourself and are therefore “less likely to recognize when you’ve made a mistake and less likely to learn from it and a complicated balance has to be struck”.
One case that stays with Dr Marsh involved a 15 hour surgery to remove a tumor from the brainstem of a teacher in his 50’s. It all went well until the very end of the marathon surgery when he was trying to get the last bit of the tumor and nicked an artery. The man was left in a vegetative state. “ I should have stopped and left the last bit behind and often particularly in brain surgery, the best is the enemy of the good. It was best to compromise and leave a bit of the tumor” Marsh recalls.
Henry Marsh is retired now. He says the book is not just about his career, but about his industry. “Medicine is a very uncertain business. It’s not like going to the garage and and getting a spare part to fix your car. There is pressure now to commercialize medicine, to privatize it and treat it like a business. It’s more difficult than that and I wanted to express that as well.”