Do No Harm, Henry Marsh.

We did this in my bookgroup. I had expected to be captivated by this book, but was not.

I found the style of writing to be rather ‘Aren’t I a great surgeon, especially as I can be so humble and tell you about my mistakes?”

Of course, ‘the doctor’s mistake’ is currently topical, given that a doctor was recently struck off for admitting to a mistake in her appraisal document. The cost to the NHS of claims for negligence has risen every year. *

Too often I found the style patronising, though he does acknowledge his unwarranted frustration that people don’t appreciate how important he is, and how much he resents having to queue in the supermarket with the hoi-polloi, for example.

One topic where he could have made a contribution to understanding hospitals is the question of ‘not enough beds’. This he rails against in several chapters, but he does not explain what that means – it is not just the physical bed that is lacking. He alludes to it in the Intensive Treatment Unit (ITU) where he says he sees “the unconscious patients on ventilators surrounded by machinery, with a nurse at each bed’.  It is not just the beds are unavailable, but the nursing staff, ventilators, supplementary machinery and the staff to clean them, administer them….; in fact the whole support system.

On the topic of the EWTD, the European Working Time Directive, he claims that junior doctors cannot get enough experience if they don’t work 120 or more hours a week. Quality training time does not equate to simply being there. Having had the experience of a doctor examining me when he was unable to wield the speculum and seemed only kept awake by drugs himself, I am in favour of the EWTD.  If this means that the doctors take more years to train, then so be it.

The clinical language is, I think, overdone, and I have a fair idea of what most of the terms meant.

I did learn some things I did not know before, but on the whole I was disappointed.

However, the rest of my book group thought it good and gave it a high score.

* Hospital Negligence Claims”

  • Claims: In the BMJ in 1994, Fenn et al reported an estimate of £52.3 million for the cost of hospital negligence claims borne by the NHS in the financial year 1990-1. Since then both the cost and incidence of negligence claims are widely believed to have soared in the wake of restructuring of the health service and NHS indemnity, by which process the financial responsibility for clinical negligence has been shifted to the provider hospitals and away from the individual clinicians. Overall expenditure on clinical negligence by the NHS in England in 1998 was estimated at £84 million.

http://www.bmj.com/content/320/7249/1567.full.print

In 2013 Margaret Hodge, chairman of the Commons public accounts committee, said “ More than £1bn was spent on settlements last year, but around one quarter of costs are spent on legal fees. The trend is really concerning. Some of this is about ambulance-chasing lawyers, but more than that I think this reflects problems with the quality of healthcare, and that is a major concern.”  Katherine Murphy, chief executive of the Patients Association, said: “I think the public has become far less tolerant about putting up with appalling failings in care, but most people only pursue legal action when every other avenue has failed. Most people who contact us say that all they wanted was an explanation of what went wrong, and changes made so that nobody else would suffer.”

Not a good situation…..