The neurosurgeon Henry Marsh has proved to be as much of a dab hand with a pen as he is with a scalpel.
His first memoir of his life in the operating theatre, the prize-winning Do No Harm: Stories of Life, Death and Brain Surgery, has sold more than a million copies since its publication in 2014.
The follow-up, 2017’s Admissions: A Life in Brain Surgery, has also received rave reviews and proved popular with readers.
Indeed, Marsh’s success has spawned a sub-genre of medical memoirs, with a flurry of autobiographical books by doctors having appeared in the past two or three years.
Marsh is now at work on his third book, although during an appearance at the UEA Literary Festival with Professor Christopher Bigsby, he admitted that there was no cast iron guarantee it would appear.
“The first two books were quite easy. All I did was write about my daily life based on the diary I’ve kept since the age of 12. If there’s going to be a third book – I refused an advance – it’s going to be more philosophical,” he said.
The son of an eminent human rights lawyer, Marsh was not destined from an early age to enter the medical profession.
Unusually for a British doctor, he completed a degree in an unrelated subject, Philosophy, Politics and Economics at Oxford, before his medical training.
He believes having extra years in education before turning to medicine, as is normal in the United States, makes for better doctors.
“On the whole they’re older. They’ve done a different degree first. They’re better educated. They’re American, so they’re driven, they have the work ethic. If you ask me who my best trainees were, they’re all American,” he said.
One issue Marsh discussed was the extent to which doctors should tell the truth to a patient with a poor prognosis. His view is that doctors should never lie to patients, but equally they “must never deprive them of hope”.
“I’ve dealt with a lot of malignant brain tumours, which are invariably fatal. But there are long-term survivors,” he said.
“One percent hope is just as good as 50 percent hope. I’m telling my juniors what you really have to think terribly carefully about is how you talk to patients. Words, I wouldn’t say they kill people, but they can cause terrible damage … We learn to lie a little bit because we don’t want to terrify patients.”
When it comes to deciding what course of treatment to follow, and whether to carry out surgery, Marsh indicated that things are typically not clear cut.
“Most surgical decisions, they’re grey: about how you feel about it, how the patient feels about it,” he said.
There are, Marsh said, “psychopathic surgeons” who care little when a patient does badly after surgery. Because their conscience is rarely troubled by a poor outcome, Marsh said that such surgeons may be more likely to operate on patients who would be better off without surgery.
Typically, though, he said, surgeons carry with them what one author described as “an inner cemetery” of unsuccessful cases.
Marsh described himself as “a passionate believer” in the NHS, not least because it means that doctors do not have a financial interest in taking a particular course of action. In other countries, he suggested, operations might be carried out because the surgeon wanted to be paid.
He has done a lot of work in Ukraine, and described the case of a badly injured boy there who was repeatedly operated on despite his case being largely hopeless. Was it because the surgeon was after money, because they wanted to give the parent hope, or because they were ignorant of the boy’s true plight? Marsh suggested that it may have been a mix of all three.
“Doctors are infinitely corruptible because they’re human beings,” he said.
The costs of medical care globally are increasing, Marsh said, as populations age and rates of cancer and dementia, both expensive conditions to treat, grow ever greater.
He noted that Britain’s spending on healthcare lags behind that of several comparable nations as a proportion of GDP, and called on politicians to have an honest discussion with the public about the need to increase taxation so that budgets could be increased. Efforts to achieve efficiency savings are simply “getting blood out of a stone”.
“The government is not really confessing that if you want better healthcare, you have to pay for it,” he said.