Tuesday, 28 April 2015

Do No Harm - Henry Marsh

Title: Do No Harm
Author: Henry Marsh
ISBN: 978-1-250-06581-0
Publisher: Raincoast
Pages: 277

Henry Marsh is a renowned neurosurgeon out of the UK. He has drafted a book outlining some of his more memorable experiences over a forty year career in medicine with the intent of passing on to future generations of clinicians and surgeons some of his hard earned observations and lessons. What caught my eye, and why I have included it within my blog, was the similarity in terms of leadership lessons within his writings that may also be applied within both the military and medical contexts.

Marsh divides his book into a series of chapters that relate to a specific type of spinal or brain injury. Each serves as an introduction to a success or failure and an evaluation by Marsh on how he addressed the situation. This is not a medical text, it is a compilation of reminiscences using his medical field as a guide. He does not pull any punches and undertakes a critical analysis of himself and others as he relates the events for the reader.

Why is this relevant for a leader? A number of reasons:

1. Mentorship: Marsh instituted a process whereby junior doctors presented case files and recommended courses of action during a daily morning briefing attended by all regardless of experience. This promoted group learning and a forum within which diagnosis and treatments could be discussed. Marsh continuously challenged his doctors ensuring greater consideration and thought;
2. Empathy: He placed particular stress on the importance of not forgetting that patients and subordinates are universally human first and that this must not be forgotten when interacting with them; from both a treatment and an institutional perspective. Throughout his works he is extremely critical of the bureaucracy that treats patients as commodities as opposed to human beings;
3. Micromanagement: Marsh acknowledges that he had particular difficulty allowing junior doctors to learn by doing and being empowered to undertake procedures without his direct intervention. It is critical that subordinates be encouraged and trusted (within their capabilities) and overseen only as required;
4. Ethics: As part of his instruction regime, Marsh was a strong proponent of "because you can does not mean you should' in terms of treatment. That is to say, will the resulting quality of life merit the discomfort and risk of surgery? This oblique approach to medical intervention is very much in keeping with the mindset that leaders must maintain;
5. Error: Throughout his narrative, Marsh is quick to acknowledge his own fallibility. This is important for all as hubris is the precursor to catastrophic failure. To be an effective leader or professional, it is critical that we recognize our own shortcomings; and
6. Knowing When to Challenge: The author acknowledges that, with maturity, came a realization that he could not win every fight and that indeed, he was foolish to try. The recognition of what was truly important served to focus his attention and improved his time management;

The most important aspect of this book from a leadership perspective; however, was his ability to make decisions and function effectively as a doctor despite the fact that he had not been able to save all of his patients; indeed some that he had successfully operated upon were paralyzed, left with significant disabilities or were not cured but only provided a brief reprieve. Neurosurgery can easily lead to catastrophic failure and requires a deep conviction and mental strength to undertake for both surgeon and patient. Many in leadership positions become incapacitated by PTSD (Post Traumatic Stress Disorder) and are thus unable to continue with their responsibilities. Marsh writes very personally about his struggles to reconcile his role as a healer with the shortcomings that he has inevitably experienced. He assumes an empathetic 'real politique' perspective that maintains his touch with patients while concurrently strengthening his mental capacity to deal with those times when the cure 'was worse than the illness'. This is a critical lesson for leaders to learn and emulate.

A fascinating and engaging read for all regardless of ones experience level. Marsh has provided outstanding lessons and mentorship beyond the surgical ward.

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