Review of Do No Harm



British neurosurgeon Henry Marsh’s book Do No Harm gives readers a gritty look at the daily trials of practicing surgery as a consultant at St. George’s Hospital in Great Britain’s National Health Service (NHS).

A fascination with a single aneurysm clipping case as a trainee turned into a 35 year career in neurosurgery for Dr. Henry Marsh. Dr. Marsh’s autobiography recounts his career while simultaneously thoroughly educating his readers. Each of the book’s 25 chapters is aptly named for an operable neurological disorder such as Pineocytoma, Aneurysm, and Haemangioblastoma. Ironically, Marsh explains early in the book that the surgical aneurysm clipping procedure that first piqued his interest in the specialty was eventually subjugated by new technology and the discipline of interventional radiology. Marsh is now rarely consulted on aneurysms.

As he has aged, Marsh has increasingly exercised great restraint in deciding when not to operate.  He often finds himself operating multiple times on the same patients to remove recurrent tumors.  For the most aggressive cancers, he must ultimately provide patients and their families with the unpleasant news that repeated surgeries are futile exercises, and that they can never stop the cancer from recurring.

Neursurgery is a microscopically delicate effort, and Marsh has learned firsthand that the risks often truly do outweigh the possible benefits. Time and experience have given rise to his realization that neurosurgeons fail so often that the few successes they achieve feel especially heroic. Marsh cites several examples of cases wherein his patients were irreparably damaged during surgery.

In one case, Marsh leaves a trainee (resident) to start a simple surgery while he goes next door to meet a nurse manager. When he returns, Marsh is shocked to find that the resident has made an egregious error and completely severed a nerve that will leave the patient’s ankle lame and unresponsive for the rest of his life.

Over time, Marsh has also learned to frame the surgical risks so patients and their families can ask themselves serious decisions in the context of questions like “If your elderly mother is paralyzed by the surgery, are you prepared to become her constant caregiver for the rest of her life?” He has found that patients’ decisions are greatly influenced by how he frames the situation.

UK Medical FeesPerhaps the most interesting and entertaining aspects of the book are Marsh’s comments and opinions on Britain’s NHS and his hospital’s administration. When he is personally injured on multiple occasions, Marsh is always quick to announce that he has private health insurance, and that he is entitled to a higher level of benefits than those without it. When Marsh’s leg is broken, he elects to be treated in a private surgical hospital rather than his own public hospital.

Eight chief executives have rotated in and out of Marsh’s hospital during his tenure. While acknowledging that the chief executive role is challenging and a task that even he would not want to undertake, Marsh is perpetually thwarted in his attempt to practice medicine throughout the book by perceived barriers erected by the hospital’s administration and the British government. On several occasions, when Marsh pushes back on administration rules or policies he is stonewalled with the response that the policies are deemed to be statutory.  In other words, the government sets his hospital’s policies, so there is no use trying to argue about it.

Marsh’s sharp quips about Britain’s public health system make it nice to know that the U.S. is not alone in its challenges. However, Marsh’s portrayal of overall subject matter of neurosurgery is fairly bleak. Only those with the grit to read through all the doom and gloom should attempt to conquer this book.

Do No Harm can be purchased from and most book retailers.