{"id":39727,"date":"2017-07-27T09:23:33","date_gmt":"2017-07-27T08:23:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=39727"},"modified":"2017-08-09T15:49:40","modified_gmt":"2017-08-09T14:49:40","slug":"niamh-brooks-to-be-a-good-doctor-can-be-painful-career-advice-from-henry-marsh","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/07\/27\/niamh-brooks-to-be-a-good-doctor-can-be-painful-career-advice-from-henry-marsh\/","title":{"rendered":"Niamh Brooks: “To be a good doctor can be painful”\u2014career advice from Henry Marsh"},"content":{"rendered":"

What does it take to be a good doctor today?<\/p>\n

<\/p>\n

\"\"<\/a>
Henry Marsh<\/figcaption><\/figure>\n

\u201cI don\u2019t want to put you off,\u201d says retired neurosurgeon Henry Marsh to a group of junior doctors and trainees at St George\u2019s Hospital, London. \u201cHowever, to be a good doctor can be painful.\u201d<\/p>\n

But the audience at St George\u2019s needs no reality check. One person at his talk<\/a> asks Marsh how doctors can prepare for a career that is so easily threatened by litigation. Another asks about his greatest mistake in medical practice. There\u2019s plenty of evidence that the \u201cpain\u201d of being a doctor is appreciated, if not yet experienced.<\/p>\n

In his newest book Admissions<\/em>, Henry Marsh reflects on his career with pride and a sense of privilege, but also says, \u201cI am not sure if I would take up medicine or neurosurgery now, if I could start my career all over again.\u201d This is partly because of his preference for some of the more challenging surgical work (operating on cerebral aneurysms, for example), which has now become redundant. But he also mentions how difficult it can be for today\u2019s doctors to find support and the amount of regulatory bureaucracy they face. Doctors are required to be empathetic and at the same time ever conscious of blame and litigation, he says.<\/p>\n

As a young person, Marsh did not plan to go into neurosurgery, or even into medicine. After an unhappy spell at Oxford University he dropped out of a degree course in politics, philosophy, and economics and took a job as a porter at a hospital near Newcastle. \u201cI hoped that by seeing other people suffering with \u2018real,\u2019 physical illness I would somehow cure myself,\u201d he says. During that time he was inspired by the hospital\u2019s general surgeon, the father of a friend, who gave him a job in the operating theatre. \u201cI find it extraordinary that he did this,\u201d Marsh says, \u201cjust as I find it remarkable that my Oxford college agreed that I could return after a year\u2019s truancy.\u201d<\/p>\n

Marsh recognises that his experience of pursuing a medical career was very different to that of today\u2019s UK students. \u201cWe are one of the few countries in the world that specialises so early (most students in the UK study three subjects at age 16+, with the emphasis on sciences for medicine), and yet many areas of medicine don\u2019t require such in depth scientific knowledge,\u201d he says. \u201cSurgery, for example needs a very specific set of skills and the technical side is relatively straightforward to learn. It\u2019s the decision making that\u2019s difficult, because of the uncertainties involved.\u201d<\/p>\n

Instead, medicine relies on critical thinking, assessing evidence, and decision making based on probabilities rather than certainties, Marsh says. Above all, being a good doctor requires the ability to listen. Medical students and doctors are increasingly encouraged to hone their communication skills, and to put themselves in their patients\u2019 shoes. But Henry Marsh steers clear of the word \u201cempathy,\u201d preferring instead \u201crational compassion.\u201d<\/p>\n

\u201cYou shouldn\u2019t be unaffected<\/em> by what your patients are going through\u2014you do need to have the emotional needs of the patient and their family in sight\u2014but in reality you will keep your patients and their families at bay,\u201d he says. \u201cIf you did [empathise] at all times you\u2019d never get your job done.\u201d<\/p>\n

Marsh says that the most successful doctors are those who \u201cget on\u201d with colleagues in all areas of their working environment, from nurses to cleaners, to senior consultants. \u201cGone are the days of surgeons discarding their gowns on the floor of the scrubs room for someone else to pick up.\u201d This is especially important since higher staff turnover and shift work mean that junior doctors today are less likely to experience the camaraderie that Marsh\u2019s generation did when they worked in one place for an extended period, or with the same group of colleagues. Junior doctors now have shorter working hours, but they have fewer opportunities to consult managers and mentors, Marsh notes. This can lead to the feeling that \u201cyou are a small cog in a big machine.\u201d<\/p>\n

In Admissions<\/em> he recounts an incident where he rages against a nurse for refusing to follow his instruction in a patient\u2019s postoperative care. Describing himself as \u201covercome with rage and almost completely out of control,\u201d he later feels contrition and shame at his impulsive response. But the incident also highlights his frustration with the hospital\u2019s systems, where patient care seems uncoordinated, and there is little rapport between hospital staff. It is only because one colleague has \u201csome of the comradely atmosphere of the old hospital\u201d that Marsh is saved from facing formal disciplinary proceedings.<\/p>\n

Good senior leadership and an apprenticeship between junior and senior doctor will help the junior doctor learn from their mistakes, Marsh says. \u201cAnd you will make many mistakes in your career. They are shattering experiences because patients expect us to be superheroes.\u201d His advice to junior doctors is, \u201cdon\u2019t be ashamed. Speak up\u2014never just plough on regardless if you\u2019re unsure about something.\u201d<\/p>\n

At the same time, he says in Admissions<\/em>: \u201cI wish the authorities in the UK understood just how difficult it is for a doctor to say sorry […] the General Medical Council orders us to tell patients whenever a mistake has been made, both in person and in writing\u2014it\u2019s usually the duty of the senior clinician responsible for the patient to do this, and to apologise, irrespective of who had made the mistake.\u201d But (and he continues to quote the GMC), \u201c\u2019for an apology to be meaningful, it must be genuine.\u2019 There is no discussion of how this contradiction can be resolved.\u201d<\/p>\n

Admissions<\/em> describes the doctor\/surgeon experience, but it is also a commentary on the NHS; on the problems of providing healthcare in countries where resources are lacking; and (perhaps unsurprisingly for a neurosurgeon) the grander themes of consciousness, memory, and mortality. In particular, Marsh describes the human brain as \u201chardwired for hope\u201d and calls on doctors to tap into this facility in all aspects of patient care.<\/p>\n

\u201cA good doctor will speak to both the dissonant selves of a dying patient\u2014the part that knows that it is dying, and the part that hopes that it will yet live. A good doctor will neither lie nor deprive the patient of hope, even if the hope is only of life for a few more days.\u201d<\/p>\n

Niamh Brooks<\/strong> is a technical editor at <\/em>The BMJ.<\/em><\/p>\n

Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

What does it take to be a good doctor today? […]<\/p>\n

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