A response to Henry Marsh

Doctors and team working

In yesterday’s Guardian, Henry Marsh, the former neurosurgeon, wrote a short piece commenting on the treatment by the legal system and the media, of transplant surgeon Simon Bramhall – otherwise known as ‘SB’.

Marsh expressed his opinion that although Bramhall had been stupid to write his initials with an argon laser on the liver of a transplanted patient, as he says, ‘It is worth noting that Bramhall had done this in full view of all of the surgical team.’ As if it wasn’t just Bramhall who was culpable but all the other surgeons, anaesthetists and nurses present in the room.

Marsh continues with a defence of surgeons in their requirement to detach sentiment from emotion and the overall pressures of being a doctor in an overstretched 21st Century NHS.

It was the ‘view of all the surgical team’ that got me.

That and the consideration that an over empathic surgeon might be a bad, if not dangerous thing.

I have met many surgeons in my career and the only surgeon I would hope to have transplant my liver or any organ would be one who is not only highly skilled but also highly empathic.

Do you want someone rooting around inside your body, making life and death decisions who does not have a moral compass? After all, isn’t morality a bedfellow of empathy, in other words, humanity; otherwise, get rid of the surgeon and bring-on the transplant bots.

It was this and the team, who either silently stood by and said nothing as SB wrote his initials, complicit in their passivity or, who thought so little of his act, seeing it as within the realms of daft but not terrible, to say nothing.

This makes me think of the Korean Airlines pilot allowing the plane to fly into a mountain because the team were all too afraid to point-out the inevitable to the captain… Mitigated language as Malcolm Gladwell says – ‘Erm, I think we might be a little too close to that…’

Livers, organs in general and surgery whether the most expert or the seemingly trivial is not, at least in a modern NHS the accomplishment of one hero operator. It is the combination of tens, often hundreds of skilled individuals all working together in what is in general considered the ‘surgical team’ – and it is team that to me is inconsistent with ‘SB’ – he didn’t write ‘the surgical team at…’ but rather, his own name, forgetting the involvement of all the other people, forgetting the person who has died, their families and dependents, forgetting the patient.

Modern health and probably, social care, can only exist within the complexities and challenges we face through team working. As the King’s Fund described in a 2011 report, there are ‘No More Heroes’ in care.

Empathy is essential to teamwork, whether you are a top-notch surgeon, battle commander or airline pilot. Without empathy, you tend to have dysfunction which diminishes the outcome of a team’s ability to perform.

Great teams – whether in football, rugby or science succeed by the combined efforts of the whole, not the talent of a star performer.

The act of writing ‘SB’ wasn’t that terrible, it did the liver or even the patient no harm – we don’t know what effect this will have on other people opting to donate their livers or enter into discussions with transplant teams in the light of this case, yet, it talks to what is great, what is the only way the NHS will continue to grow and survive within the constraints of modernisation, integration and progress – that is, humility, empathy and collaboration.

Originally published at almondemotion.com

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