Doctor of humility

Henry Marsh’s book Do No Harm (2014) was that rare thing — a neurosurgeon showing his fallibility in public and admitting to the great harm that good intentions can cause. It was a stunning, even revolutionary work, displacing doctors from their traditional ivory towers and showing them to be not only human and vulnerable to misjudgments, but also capable of self-admonishment and regret. At the time, I said it should be required reading for medical students.

The follow-up, Admissions, continues the theme of self-examination. Marsh is an atheist, and in many ways his writing is like a secular confessional — hence the dual meaning of ‘admissions’. So unsparing is he in his self-criticism that there is no mention of the thousands of patients he has saved from dismal death: he concentrates almost solely on his perceived mistakes — in his personal as well as professional life.

Admissions has a wider scope than the first book. Marsh walks us briefly through his parents’ lives — his Oxford don lawyer father saved Marsh’s anti-Nazi German mother from having to give evidence against her workmates by marrying her — and touches on his childhood. Despite his almost masochistic urge to criticise himself, the book is frequently very funny. Marsh is impatient with the bureaucracy that now governs the lives of clinicians, and many doctors reading this book will, like me, silently cheer him on for his controlled sedition against the petty managerial rules and regulations that hinder clinical care. On one occasion, at the neurosurgical meeting, a trainee states that an octogenarian was sent home by the local hospital despite his legs not working. ‘But he couldn’t fucking walk’ chips in an anonymous voice of protest. Nowadays, these are the minor mutinies clinicians are reduced to against the chronic lack of resources that mean hospital staff spend hours hunting for beds and trying to negotiate theatre time.