So you’ve been told you need an operation. Can you be sure that you really should go under the knife? What is the risk of having surgery? Or the risk of not having it? Is the timing of the operation ideal for you? Is your hospital any good? Is your smart and smooth-talking surgeon with an excellent bedside manner competent?
More than 30 years have passed since I stood as a mere medical student before an audience of distinguished surgeons and delivered a talk in which I examined the success rates of their operations. I did not expect to be ostracised for daring to bring this into the open and I would never have anticipated this early skirmish with the medical establishment would lead to a lifelong dedication to the evaluation and improvement of surgical outcomes.
The subsequent two decades brought about a revolution in medical care in the UK. For the first time, the quality of care became measurable and, as a direct consequence, my own speciality of heart surgery made a quantum leap towards better and safer outcomes for patients.
Why write a book about it? Well, the public has a right to know what happens behind the operating room door. The “patient” is evolving into a “healthcare consumer”. There are reams of data available about the myriad medical and surgical treatments and the people who dish them out. My book provides you with the tools to interpret this information. Also, the study of medical risk is a young science that is constantly breaking new ground – and it is fascinating.
Not so long ago, even the most eminent doctors treated patients with absolutely no evidence that their treatments did any good. In fact, many treatments did a lot of harm. Nowadays, doctors practise evidence-based medicine, meaning that the effectiveness and safety of the treatment is backed by solid, scientific facts. The next step on the ladder towards even better medicine is how well these treatments are administered. This covers everything from performance of an operation through to the preoperative and postoperative care. It also includes the safety and quality mechanisms integrated into the structure and the governance of the hospital providing the treatment. This medical “breakthrough” is recent and has only just begun, in the last 20 years or so, to receive the attention it deserves.
Many things contribute to your surviving an operation. Discoveries in this field have been true eye-openers. Good technical surgery is very important, but surprisingly human factors, including holidays, recent events, communications and surgeons’ personalities, play a part. In fact, the only factor that seems to make not a scintilla of difference to whether you survive an operation is your choice of anaesthetist.
Data about surgical outcomes are now in the public domain in Britain. We are now beginning to have true transparency in healthcare and, in that regard, heart surgery leads the way. Transparency, although generally considered a good thing, also has unintended and nasty consequences that can cause patient harm. In The Naked Surgeon, I show the benefits of transparency, but also draw attention to the many pitfalls. In addition, I hope to give you insight into my world of heart surgery, one full of drama and humanity.
At one time or another we all have to make decisions about our health. Understanding the system, its mechanisms and thought processes, can help us make the right decisions about what can often be a matter of life or death. That’s why I wrote The Naked Surgeon.
Extract
What is amazing about heart surgery is not that it exists and works, but that it took so long to appear. After all, the heart is a pump, pure and simple. When something goes wrong with a pump, it is a plumbing problem, needing plumbing solutions. How else do you fix a blockage in a pipe, or a leaky valve? Yet, for more than 2,000 years, the heart was exclusively the domain of the physician, not the surgeon, and woe betide the surgeon who dared touch it. The taboo on operating on the heart was so strong that Theodor Billroth, one of the great founding fathers of modern surgery, stated in 1889 that “a surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues”.
More about The Naked Surgeon
Doctors are supposed to have a bedside manner: Nashef has the authorial counterpart, a knack of even making you care, for instance, about the mechanical properties of the suture material Prolene (this isn’t a mere technicality but a life-and-death matter about which Nashef cares deeply). – Peter Forbes
Buy the book
The Naked Surgeon by Samer Nashef is published by Scribe Publications at £8.99 . and is available from the Guardian Bookshop for £7.37.
