Do No Harm summary

Henry Marsh has been a Consultant Neurosurgeon at London’s Atkinson Morley’s and St. George’s Hospital since 1987. It is his hope that his stories will help people understand the difficulties doctors face – difficulties that often have more to do with human nature than technical setbacks.

One such difficulty is our ability to empathize. The author recalls that, when he was a medical student, it was easy to feel sympathy for patients, as he wasn’t yet responsible for the outcome of their treatments. However, as he moved up the ladder and gained new responsibilities, feeling this sympathy became harder.

Responsibility entails a fear of failure, making patients a source of anxiety and stress. Marsh, like many other doctors, became hardened over time, regarding patients as a species entirely different from the invulnerable doctors like himself.

This doesn’t mean that there is no place for hope or empathy. But striking the balance between hope and realism is difficult when developing a medical prognosis; if doctors venture too far on either side of the spectrum, they can either condemn their patients to live in hopeless despair for the remainder of their lives, or end up being accused of dishonesty or incompetence when things like tumors turn out to be fatal.

According to the author, one of the most anxiety-inducing situations in surgery is when surgeons operate on other surgeons. For instance, when he needed retinal surgery, he knew that his friend (who was also a doctor) saw this request for treatment as both a compliment and a curse. In these situations, the usual rules of detachment break down – the operating surgeon feels exposed because his patient knows he is fallible.

However, this learned detachment fades over time. Now that the author is older, he has become less frightened, and more accepting, of failure and mistakes. He’s realized that he is made of the same flesh and blood as his patients, and is equally vulnerable and fallible.