By Chet Yarbrough
Written by: Henry Marsh
Narration by: Jim Barclay
An interesting insight offered by Henry Marsh’s memoir, “Do No Harm”, is a contrast between American and British Medicine. Marsh’s candor about his life and profession surprise his audience. “Do No Harm” endears his curmudgeonly personality. The surprise is in Marsh’s profound empathy and personal conflicts that accompany his neurological decisions.
Marsh’s endearment comes from explicit “f-word” rants about British National Health Care’s under-funded technology, bureaucracy, and medical treatment.
In addition to his rants, Marsh endears himself by explaining the fine line distinction between physician’ hubris and self-confidence; i.e. a distinction good physicians need–to understand their limitations, and competently treat their patients. Jim Barclay’s narration perfectly suits the tone of Marsh’s memoir.
Marsh is able to enter into medicine with little education in the sciences. Either by dint of a formidable intellect or a quirk of the British education system (maybe both), Marsh takes all his science courses after deciding to become a doctor. One doubts an American medical school would have considered his application in the 1960s.
Marsh graduates and begins his career in medicine under the guidance of experienced physicians. As he acquires experience, he chooses to specialize in neurological medicine under the supervision of a Consulting Neurological Physician. The Consultant (a neurology physician trainee’s guide) works within the English National Health Care system as a qualified physician who supervises aspiring neurological physicians. This consultant chooses cases for trainees; under varying levels of supervision.
Though a neurological procedure may be done by a trainee, the consulting physician is responsible. This appears to be similar to internships in the United States. However, an interesting difference is insurance. English’ hospitals carry a trust to protect physicians from mistakes made by physicians in treating patients. This may be an insurance distinction without a difference but, as in all medical service systems, mistakes do occur and patients are harmed.
Marsh completes his trainee experience and decides to become a Consulting Neurological Physician in the national health care system. Marsh surprisingly reveals several mistakes he and his trainees make during his years of consultancy. In revealing those mistakes, a listener pauses to think about risks patients take when depending on physician’ medical knowledge and experience. Marsh’s stories reflect on British’ medical training, family apologies, and personal anguish over patient’ quality-of-life and death issues. Marsh explains the best a Consultant Surgeon can expect from surgical mistakes is to avoid repetition. The worst, for Marsh, is the consequence to patients and apologies to families for the mistakes made. In contrast to Marsh’s way of addressing mistakes with transparency, American’ physicians seem more likely to avoid family apologies while hiding behind legal and insurance company shields.
The message in Marsh’s book is the failure of the English National Health Service to provide adequate care for the general population. He notes the long lines of patients who wait for attention when rapidly growing tumors are destroying a patient’s neurological system. Marsh complains of inadequate bed availability for patients that need operations. Financing for the National Health Service is inadequate for the number of patients that need help. The subliminal message is that any national program for public medical treatment must be adequately funded.
Marsh notes that he carries private health insurance to supplement his family’s medical needs. (An alternative not financially feasible for the poor.) At the same time, he infers private hospital services tend to gouge patients for their medical service; partly, because of charges for unnecessary tests and superfluous operations. Physicians in the private sector are seduced by the opportunity to make more money; often at the unfair expense of unwary patients. In spite of Marsh’s swipe at private medical practitioners, he attacks the bureaucratic nature of the National Health Service that hires hospital administrators who are directed to reduce costs; regardless of patient’ load or patient’ need. Technological improvements for England’s National Health Service are delayed because of lack of financing, poor administration, and inadequate training.
Marsh leavens his criticism of England’s national health care by writing of his experience in the former U.S.S.R. (specifically Ukraine) where problems are monumentally greater. In the end, America’s effort to improve national health care is tallied, in one’s mind, against the current English picture painted by Marsh. For medical patients, the English system seems riskier than the American system. Doctors in England seem more insulated from medical mistakes. If doctors are more insulated, they may take greater risks; i.e. risks that can lead to patient’ disablement or death. The American system, if one can afford the service, seems more conservative and less likely to do harm.
It seems England’s national health care offers a level of societal comfort because there is hope for affordable treatment. Marsh clearly shows how government bollixes National Health Care with inadequate funding and a bumbling administrative system. However, England’s private system has not met the needs of citizens who can afford the additional service. The private system suffers from human nature’s folly; i.e. the lure of wealth at the expense of fairly priced or truly needed medical treatment.
Is medical health service a human right or privilege?
One draws their own conclusion about British and American Medicine. Marsh does not answer the question but suggests adequate health services revolve around physician’ empathy and medical treatment transparency. Marsh shows the monumental problems of affordable health care in England. A listener of “Do No Harm” infers equally challenging problems in America.