The Naked Surgeon
The power and peril of transparency in medicine
Samer Nashef
“We are not meant to touch hearts. We all have one, but most of us will never see one. The heart surgeon now has that privilege but, for centuries, the heart was out of reach even for surgeons. So when a surgeon nowadays opens up a ribcage and mends a heart, it remains something of a miracle, even if, to some, it is merely plumbing. As with plumbers, the quality of surgeons’ work varies. As with plumbers, surgeons’ opinion of their own prowess and their own attitude to risk are not always reliable. Measurement is key. We’ve had a century of effective evidence-based medicine. We’ve had barely a decade of thorough monitoring of clinical outcomes.”
As someone who has a regrettably bad grasp on statistics, this book was fantastic! It explained some pretty complex modelling scenarios in a way that didn’t make me feel stupid and that I’m certain a non-scientist would understand. I didn’t expect to enjoy reading it, but the author does a great job delivering the material in a way that kept me preferentially keep going over other parallel reads I was doing. Also, I felt the need to share some random facts with others in my vicinity. Cool stuff!
It’s terrifying to think about the success rates of some of the earliest surgical interventions. Reading old veterinary novels (eg. James Herriot) reminds us of a time when medicine wasn’t actually all that good at fixing things! I think that’s it’s quite common that if you are facing surgery you just trust that the surgeon is going to do the right thing, and try to get a good outcome for you. This is particularly true in Australia and Britain where the public health system is free/low cost. This book is a timely reminder to check your options and seek a second opinion if you need one. Trust doctors, but also do your own research.
This book was quite British based, but still has relevance to healthcare around the globe. I found it so interesting to see that my preconception that governments see the most ‘efficient treatment’ to be the cheapest as true. Sometimes (perhaps even always?) this might lead to poorer patient outcome in terms of survival – because someone who dies on the operating table doesn’t have any expensive post-surgery rehab!
I recently lost an uncle to a mostly unexpected heart attack after he’d already had a successful intervention earlier in the year. I’m certain that his surgeon is one of the ones who obsesses over those that they lose and improves from that loss. The other heart scenario I have personally encountered is an aortic dissection – which is actually quite rare! All this sends home the message that even though heart surgery has come a long way it’s still better to keep yourself in shape to stay out of the operating theatre.
It’s a book best ‘enjoyed’ slowly, so that you can let the statistics sink in. I’d keenly read more books by this author, if he chooses to share his thoughts on other medical topical matters.
