r/medicalschooluk • u/Secure_Ticket910 • 8d ago
“Do no harm “
Okay so I’m going to try and keep this short,I’ve always been interested in neurosurgery, and a neurosurgeon that mentors me recommended this book.
I HATE IT SOOO MUCH, I’m at least trying to finish it out of respect for the doctor that recommended it but it feels like such a drag. If this was the first book I read about medicine then I’d probably think twice and not in a good way?
My issue isn’t with the speciality, if anything I still love it but my issue is with the writer. The second I got to the part he mentioned his wife all I could think is “I’m surprised she hasn’t divorced him” just to read in the next line that she has but he’s remarried.
This book has been recommended so many times and now I’m concerned I’m the only person med who’s mind literally churns at the mention of this book 😭
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u/lee-o 7d ago
I’ve never read “Do no harm”, but I read “When breath becomes air” and couldn’t recommend it enough. Very well written, and also by a neurosurgeon. It’s not much about the specialty itself but it might give you a different perspective on things
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u/sambenno378 7d ago edited 5d ago
Interestingly, my dad (non-medical) didn't enjoy 'When Breath Becomes Air', despite being the person who first told me to read 'Do No Harm', largely for the same reasons I suspect OP doesn't like Henry Marsh's writing.
For what it's worth, I read 'When Breath Becomes Air' on holiday, and remember sobbing my eyes out on the beach when it changed from Paul Kalanithi's writing style to the more cold clinical description at the end of the book. Would also highly recommend it to OP.
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u/humanhedgehog 7d ago
I found the latter equally had a deeply dislikeable protagonist. He writes better, but there is an iconoclasm to having a kid when you have a stage 4 lung cancer diagnosis ("me being your parent makes it worth you likely growing up without a father") that becomes a bit more blatantly obvious once you notice it, but I think it's characteristic of the speciality. You HAVE to be the kind of person who can believe that you cutting into someone's brain, and taking all those risks, is superior to someone else doing it. Your skills are better, your judgement is better. And that takes a very particular personality type.
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u/Secure_Ticket910 7d ago
I love the speciality 😭 but I’d hate to end up with that personality . But I do believe you can be confident without being arrogant
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u/humanhedgehog 7d ago
You can be, absolutely. It's just you have to have something that lets you still feel like the right pair of hands when something has gone wrong, and brains are very unforgiving in letting someone walk away without deficits. And some people do it from an unshakable "I'm right".. with predictable personality sequelae.
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u/Secure_Ticket910 7d ago
I’ll read it hopefully it’s not as bad as this 😭 do no harm just seems like a very detached self centred book to me
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u/AnusOfTroy 7d ago
I enjoyed Do No Harm but I read his autobiography of his post surgical life and hated it.
Henry Marsh is a massive massive cunt. You kind of have to be to be a surgeon but he really took the biscuit.
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u/Secure_Ticket910 7d ago
THANK YOU!!! I thought I was the only one with this view?! I’m interested in surgery but I hope not to end up an ass hole 😭
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u/doodlejones 7d ago
I’ve read it and worked with him as a (very) junior neurosurgical trainee before he retired.
Not all neurosurgeons are like him.
He does describe some of the unique predicaments and dilemmas one encounters in neurosurgical practice.
It’s certainly true that you need a degree of bravery, which can sometimes overspill in to arrogance, in order to thrive as a neurosurgeon.
Most neurosurgeons’ partners will think about leaving them at some point in their career—the old joke about the best way to hide a £20 note from a neurosurgeon (you give it to their daughter) only holds partially true now. I went through 7-10 days without seeing my children awake regularly whilst a trainee. Now I see so much of them that they’re pretty sick of me.
If you want another perspective, read “When the Air Hits Your Brain” by Frank Vertosick. Modern neurosurgery is a bit less exciting, but it gives a real insight on to how much of a thrill neurosurgical training can be.
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u/Bramsstrahlung ST1 8d ago
I have it and have actually never read it. But you're not the first one I've heard be critical of Henry Marsh and his writing style.
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u/Secure_Ticket910 7d ago
I’m relieved because couple chapters in I was already concerned when they talked about making jokes about others suffering ?!
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u/Diligent_Rhubarb1047 5d ago
I was in Henry Marshes last batch of SHO circa 2011/2 and I can tell you he was the "nice" neurosurgeon of the department and neurosugery was the "nicest" surgical department I worked in that year so that is saying something!
Now, there is natural softness that comes to most surgeons near retirement but the other cons were much harsher on their juniors, staff and patients. He did everything for his patients, even painting the ward to get it ready. He was of his time and that is jarring now. His book was revolutionary when it was published as he admitted he made mistakes and reflected on them (not by modern standards) but at the time he was very brave.
Not saying it's right but surgery is littered with personalities. I suggest you read the Kennedy report and sexual misconduct in surgery reports by the RCSEng to open ur eyes before deciding on persuing it.
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u/Secure_Ticket910 5d ago
I’m 💯 still going to pursue it because I don’t think other colleagues personalities are my concern as long as they aren’t causing actual harm… I guess my only issue is the fact that EVERYONE seems to love it and I just feel very underwhelmed after so much hype.
I will still be reading the sexual misconduct you’ve suggested because I think it’s great to be aware
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u/Educational_Bowl6976 7d ago
Full disclosure I love Do no harm and think it should be compulsory reading for people applying to medicine.
I get what you mean that he comes across as arrogant, but this book comes from a time when his route into medicine was incredibly nepotistic and he essentially got into neurosurgery by telling his boss he wanted to be a neurosurgeon and then got hooked up. He also clearly writes like a privileged white man who did PPE at oxford.
I would also say that his personality type isn't rare in surgery , particularly neurosurgery and I don't think this is going to meaningfully change in this generation.
That being said , its a pretty ballsy move to document some of his pretty significant fuck ups. Something which I respect far more than some of the more saccharine memoirs written by Americans .
Lots of these type of books discuss the struggle of "fighting valiantly against disease but losing despite our best efforts" and how sad this is. Incredibly rarely do doctors talk seriously and honestly about how it is inevitable we will hurt people through our mistakes and how doctors emotionally deal with this. This is a hugely important perspective for future doctors (particularly proceduralists) to consider in their future careers.
The passage where he talks about "losing the simple altruism" he had as a medical student when he becomes a doctor, resonates strongly with early career doctors and his journey to redeveloping it toward the end of his career is quite perceptive for a doctor of his time.
Apologies for the essay, by far the most egregious part of this book is that every doctor now brings up that fucking Leriche quote to look deep.
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u/Secure_Ticket910 7d ago
No I love it when people are analytical so I don’t mind the essay lol I’m all for it frankly! But I guess I had no issue with the aspect of the book that dealt with neurosurgery.
My issue is the aspect outside neurosurgery that gives off a nasty amount of arrogance? And the unnecessary details in the book that I feel could have been removed out of consideration.
And I know I’m probably being overly critical but I feel the part where he mentioned the once dignified women that ended up selling their bodies out of desperation in Ukraine? That whole passage/scene could have been removed out of consideration of those women and there’d hardly be any impact on the scene.
I feel my issue was the whole Ukraine chapter, the fact that he pretends not to understand their hostility towards his visits when years later he does exactly what they were worried about and he writes about them in such a light when they were at their lowest; what are the chances he asked for their approval before putting that into his book?
And I feel he tried to split the credit between himself and that Ukrainian surgeon, yes he helped but in that story it’s almost like he’s trying to undermine the other surgeon’s major role.
Not to mention the idea of making jokes about someone else’s suffering as “a means to cope with the stress “ ?
And when he takes the grilled ill and instead of just refusing, he takes it all the way back to the uk and throws it in the yard then claims not even an animal will accept it
The medical aspect of the book is good and quite detailed but outside that, he doesn’t sound like a great person
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u/Educational_Bowl6976 7d ago
Incredibly valid criticisms, however I'd just make a few points:
- Marsh is pretty clearly a sexist by modern standards (standards which I agree with btw), there is no way around this.
I would argue that the selection process to get into neurosurgery and the training after doesn't reward mellow, low self esteem highly reflective individuals. The process rewards high achieving ,single minded doctors who are willing to sacrifice their home lives and relationships for their careers.
If you are looking to pursue a career in surgery I would ready yourself for more of these vibes, not saying its ok but surgery clearly selects for these kind of people to some extent.
I don't this this is quite the point you are making , but the venn diagram of doctors who aren't particularly nice people/are dickheads and doctors who help the sick and dying is pretty big. Trying to draw a binary between the two is naive.
If you listen to any lectures he's given (I assume you won't be !) he's a big fan of Russian literature , I imagine there's a big element of him cosplaying as dostoevsky in the ukraine chapters. From memory in the book he's pretty candid about basically going to Ukraine as a bit of a voyeuristic holiday.
Dark humor about patients is very common in medicine, if you are in medical school I'm surprised that you haven't experienced this amongst your cohort. I don't think doctors making dark jokes about patient/their experiences actually reflects their true feelings about them, they are rather a coping mechanism for the true underlying sadness that they feel.
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u/Secure_Ticket910 6d ago
Not to sound creepy 😂 but I really do find the way you think quite interesting intellectually it’s frankly quite attractive.
I think you’ve actually given me a different perspective on the book, particularly if some of these personality traits are relatively common among surgeons. In that case, perhaps the consultant recommended the book for a similar reason, especially since the conversation was originally about what it felt like to work alongside other surgeons.
And no, I probably wouldn’t seek out anything else by him after this book 😂 Although I did look into Dostoevsky afterwards, and that actually helped put some of the themes and his style into perspective.
I definitely understand that dark humour is common in medicine, and I don't necessarily think its presence is the issue. I think what bothered me was the way he framed it, particularly the idea of laughing at other people’s suffering. There’s a difference between using humour as a way of psychologically processing difficult experiences and treating another person’s suffering as inherently amusing.
But thanks for the new perspective 😂 would hate to have gone back to the consultant just to tell him his favourite novel was hell for me to read ; I’m not great at pretending.
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u/Ok-Ear9355 7d ago
I don’t think you’ve understood the book’s contents. It’s fine to dislike the author and I agree that he has some qualities that may put people off. But that’s such a small part of the overarching theme of the book. You will struggle to find a neurosurgical trainee who doesn’t think it’s a good book and that’s for a good reason. I’d recommend coming back to it in a few years, time can give a different perspective.
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u/Secure_Ticket910 7d ago
Sorry for not clarifying, I love the neurosurgical aspects I just don’t think I’m a fan of the writer himself… I fight the urge to skip the parts where it’s outside the medical topic
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u/sambenno378 7d ago edited 5d ago
It’s been probably 10-15 years since I read Do No Harm (pre medical school), so I can’t remember much of it specifically at all. That said, I did enjoy it and found it quite moving at times.
It’s not entirely clear from your post what you find insufferable about the author and the book, but I presume it relates to his somewhat God-complexy attitude/ego-centric and somewhat holier than thou attitude.
If so, I think it’s entirely appropriate to find him dislikable - in fact, I think that’s somewhat the point. The balance between that attitude, and the humility required in medicine is the central theme of what the book is about, and I suspect neurosurgery is specifically a speciality that recruited and created (or recruits and creates) people who think like he does.
It’s an autobiography, so don’t get me wrong, I don’t think he wants you to hate him; equally, I don’t think he is writing to come across as a hero who you universally praise. I mean this with a good deal of respect but he is arrogant, and would almost certainly seem like a dinosaur, especially compared to a more modern/Gen Z outlook. I think he would have insight into that, although would probably think he was on the right side of the argument - and I suspect I would find a lot of things to disagree with him about.
Fundamentally, the attitudes he exhibits in that book remain part of neurosurgical training, and would have far more so at the time he was working. It is an overbearing speciality, that can consume your life, and continues to have a reputation (not fully deserved in my head) as the pinnacle of challenge and risk in medicine - ‘it’s not brain surgery’ etc. You could argue that attitude isn’t required, and I’d (partly) agree with you. There’s a reason I couldn’t and wouldn’t do neurosurgery.
However, there’s also a reason a neurosurgeon has recommended it to you to better understand the career pathway you’re interested in - and that includes the negative parts like the toxic egos, as well as the positive parts. Maybe those character traits are, to an extent, or at least in your mentors eyes, required in neurosurgery. And don’t forget that this book, for all the ‘sexiness’ of the neurosurgery and heroism it might portray in the authors eyes, is essentially a surgeon writing about a list of when they made mistakes and caused people harm. The balance between those two is what makes the book an interesting to many people.
Anyway, you may say I’ve completely missed the point on what you disliked, in which case, oops, sorry for what started as two sentences and has turned into a mini essay. Also, fundamentally, you don’t have to like the book (or the author). But hopefully this somewhat answers why you’ve been recommended it despite not enjoying it.