Browse content similar to 28/12/2016. Check below for episodes and series from the same categories and more!
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Now it's time for HARDtalk. | 0:00:00 | 0:00:10 | |
Welcome | 0:00:10 | 0:00:10 | |
Welcome to | 0:00:10 | 0:00:12 | |
Welcome to HARDtalk. | 0:00:12 | 0:00:12 | |
Welcome to HARDtalk. I | 0:00:12 | 0:00:12 | |
Welcome to HARDtalk. I am | 0:00:12 | 0:00:12 | |
Welcome to HARDtalk. I am Stephen | 0:00:12 | 0:00:13 | |
Welcome to HARDtalk. I am Stephen Sackur. | 0:00:13 | 0:00:15 | |
Imagine you are a patient about to undergo brain surgery. | 0:00:15 | 0:00:17 | |
If it goes well it could save your life, if it goes wrong you could end | 0:00:17 | 0:00:22 | |
up paralysed or dead. | 0:00:22 | 0:00:24 | |
Of course you want to believe your surgeon is infallible, | 0:00:24 | 0:00:26 | |
a superhero, but he is not, he is all too human, | 0:00:26 | 0:00:29 | |
just like you. | 0:00:29 | 0:00:31 | |
And that simple truth emerges from the extraordinary honest | 0:00:31 | 0:00:34 | |
writing of my guest today, one of Britain's leading brain | 0:00:34 | 0:00:36 | |
surgeons, Henry Marsh. | 0:00:37 | 0:00:39 | |
He has given us rare insight into the mind of the doctor. | 0:00:39 | 0:00:42 | |
Is that reassuring or troubling? | 0:00:42 | 0:01:06 | |
Henry Marsh, welcome to HARDtalk. | 0:01:18 | 0:01:19 | |
Thank you. | 0:01:19 | 0:01:20 | |
The very job description brain surgeon, for most people it prompts | 0:01:20 | 0:01:23 | |
a sense of awe and maybe fear as well. | 0:01:23 | 0:01:25 | |
And certainly mystery. | 0:01:25 | 0:01:26 | |
You have decided to lift the veil on what it is really | 0:01:26 | 0:01:29 | |
like and I wonder why. | 0:01:29 | 0:01:37 | |
I have been subject to that myth of brain surgery myself. | 0:01:37 | 0:01:40 | |
I became a neurosurgeon many years ago. | 0:01:40 | 0:01:42 | |
I am the youngest of four and I have been drawing attention to myself | 0:01:42 | 0:01:45 | |
from an early age. | 0:01:45 | 0:01:50 | |
I wanted to convey that medicine is a very uncertain, | 0:01:50 | 0:01:53 | |
imprecise business. | 0:01:53 | 0:02:01 | |
When I became a doctor 35 years ago, doctors buried their mistakes. | 0:02:01 | 0:02:04 | |
There was deference and trust. | 0:02:04 | 0:02:05 | |
Doctors were not really held to account for what they did. | 0:02:05 | 0:02:08 | |
That has changed profoundly, at least in this country. | 0:02:08 | 0:02:11 | |
You cannot open the newspapers without seeing the latest medical | 0:02:11 | 0:02:13 | |
scandal. | 0:02:13 | 0:02:15 | |
It is the tabloid headlines that drive the politicians to believe | 0:02:15 | 0:02:18 | |
mistakenly that they can change things in what is a very | 0:02:18 | 0:02:21 | |
excellent health service. | 0:02:21 | 0:02:21 | |
Patients are not consumers, it's not like a shop. | 0:02:22 | 0:02:24 | |
Doctors are doing something in many ways much more difficult | 0:02:24 | 0:02:27 | |
than what people realise. | 0:02:27 | 0:02:28 | |
People think brain surgery is difficult technically. | 0:02:28 | 0:02:30 | |
Well, it is not actually. | 0:02:30 | 0:02:31 | |
The really difficult thing is the decision-making and dealing | 0:02:31 | 0:02:33 | |
with the patients and all the human problems that arise. | 0:02:33 | 0:02:36 | |
I wanted to convey that. | 0:02:36 | 0:02:50 | |
By conveying that and focusing on the difficulty and sometimes | 0:02:50 | 0:02:54 | |
the fallibility of yourself and colleagues, isn't the danger | 0:02:54 | 0:02:59 | |
that you plant a new and horrible seed of doubt in the patient? | 0:02:59 | 0:03:08 | |
I do not think so. | 0:03:08 | 0:03:13 | |
If you had to go and see a doctor and you could only choose one | 0:03:13 | 0:03:17 | |
quality, either steady hands, famous reputation, nice website, | 0:03:17 | 0:03:19 | |
nice smile, we would all go with honesty. | 0:03:19 | 0:03:22 | |
If you do dangerous surgery, which neurosurgery certainly is, | 0:03:22 | 0:03:25 | |
the mistakes all arise in the decision-making. | 0:03:25 | 0:03:34 | |
It is not about dropping something, it is not like that. | 0:03:34 | 0:03:37 | |
Occasionally purely manual errors occur, but it is very unusual. | 0:03:38 | 0:03:40 | |
In my career, looking at my colleagues, it is in | 0:03:40 | 0:03:43 | |
the decision-making where things go wrong. | 0:03:43 | 0:03:44 | |
That is all about thinking and psychology. | 0:03:44 | 0:04:01 | |
When you decided to go into brain surgery, you knew | 0:04:01 | 0:04:03 | |
you were going to a field of medicine that came | 0:04:03 | 0:04:06 | |
with enormous pressure. | 0:04:06 | 0:04:07 | |
There aren't many branches of medicine where anything | 0:04:07 | 0:04:09 | |
you could do could lead to the most catastrophic... | 0:04:09 | 0:04:12 | |
You become a surgeon because surgery is a blood sport in a way. | 0:04:12 | 0:04:15 | |
That's what I say in my book. | 0:04:15 | 0:04:19 | |
That is not inconsistent with caring for your patience. | 0:04:19 | 0:04:21 | |
What is making it exciting is being worried your patient | 0:04:21 | 0:04:24 | |
should do well. | 0:04:24 | 0:04:30 | |
That's fine, but focussing on you. | 0:04:30 | 0:04:32 | |
Is it fair to say you have to have supreme confidence, | 0:04:32 | 0:04:35 | |
maybe bordering on arrogance to become a brain surgeon? | 0:04:35 | 0:04:37 | |
It is all about balance. | 0:04:37 | 0:04:38 | |
Absolute power corrupts absolutely. | 0:04:39 | 0:04:40 | |
We have an enormous amount of power and it is easy to become arrogant. | 0:04:40 | 0:04:43 | |
You need to be insensitive to some extent. | 0:04:43 | 0:04:48 | |
This is a challenge of all medicine. | 0:04:48 | 0:04:50 | |
It is visible and acute in something like brain surgery. | 0:04:50 | 0:04:56 | |
Finding the balance between compassion and detachment. | 0:04:56 | 0:04:58 | |
The only ethic in medicine, some say, is we should only treat | 0:04:58 | 0:05:01 | |
patients as we wish ourselves or our family to be treated. | 0:05:01 | 0:05:09 | |
But it is almost impossible. | 0:05:09 | 0:05:10 | |
Finding that balance between compassion and detachment | 0:05:10 | 0:05:12 | |
is difficult. | 0:05:12 | 0:05:15 | |
That's one element of it, but also self belief and self-doubt. | 0:05:15 | 0:05:18 | |
It seems to me reading your book and other writings about the work | 0:05:18 | 0:05:22 | |
you have done, as you have gained an experience and reputation, | 0:05:22 | 0:05:25 | |
you have become more self doubtful. | 0:05:25 | 0:05:26 | |
Very much so. | 0:05:26 | 0:05:27 | |
Because I came to realise that once you master the technical skills | 0:05:27 | 0:05:30 | |
of operating, where mistakes arise is in the decision-making. | 0:05:30 | 0:05:39 | |
I believe now that other people are better at seeing my mistakes | 0:05:39 | 0:05:42 | |
than I am. | 0:05:42 | 0:05:43 | |
That is a divine truth that applies to all of us, | 0:05:43 | 0:05:46 | |
we are very bad at seeing our own mistakes. | 0:05:46 | 0:06:04 | |
You need the arrogance and self belief to do the operating, | 0:06:04 | 0:06:07 | |
but it is critical you have a good working relationship | 0:06:07 | 0:06:09 | |
with your colleagues as well so they can criticise | 0:06:09 | 0:06:12 | |
you and you can criticise them. | 0:06:12 | 0:06:14 | |
That is difficult to get doctors to do. | 0:06:14 | 0:06:26 | |
Let's get specific and talk about a case that you have been | 0:06:26 | 0:06:29 | |
very honest about. | 0:06:29 | 0:06:30 | |
It's a troubling case. | 0:06:30 | 0:06:31 | |
Earlier in your career, there was a man in his late 50s | 0:06:31 | 0:06:34 | |
who came to you with a huge brain tumour and you were appalled by it. | 0:06:34 | 0:06:38 | |
Appalled and excited. | 0:06:38 | 0:06:39 | |
You said you'd never seen anything like it. | 0:06:39 | 0:06:41 | |
He was sent off to see another consultant even more | 0:06:41 | 0:06:44 | |
senior than you. | 0:06:44 | 0:06:45 | |
He pushed it back to you and said, Henry, | 0:06:45 | 0:06:47 | |
you do it. | 0:06:47 | 0:07:02 | |
It is a young man's operation. | 0:07:02 | 0:07:03 | |
Exactly. | 0:07:03 | 0:07:04 | |
And you were quite excited. | 0:07:04 | 0:07:05 | |
It was a dozen hours or more. | 0:07:05 | 0:07:07 | |
It was longer than that and it went badly. | 0:07:07 | 0:07:09 | |
You said to yourself, I could stop now, but I will get | 0:07:09 | 0:07:13 | |
every single trace of this tumour out and before you finished, | 0:07:13 | 0:07:16 | |
you had accidentally severed a branch of an artery | 0:07:16 | 0:07:18 | |
and the man never recovered. | 0:07:18 | 0:07:20 | |
The mistake was not severing the artery, it was deciding | 0:07:20 | 0:07:22 | |
to remove that last bit of tumour. | 0:07:22 | 0:07:24 | |
How do you live with that? | 0:07:24 | 0:07:25 | |
The answer is all neurosurgeons have terrible disasters | 0:07:28 | 0:07:30 | |
and periods of despair. | 0:07:30 | 0:07:35 | |
When I first became a consultant, my first few bad results I felt | 0:07:35 | 0:07:39 | |
quite sick and miserable for weeks on end. | 0:07:39 | 0:07:49 | |
You have to go on working. | 0:07:49 | 0:07:50 | |
In a sense you accept it. | 0:07:50 | 0:07:52 | |
Has it changed the way you work? | 0:07:52 | 0:07:54 | |
We have talked about confidence and self-doubt. | 0:07:54 | 0:08:05 | |
You develop blinkers. | 0:08:05 | 0:08:06 | |
You need to deceive yours elf to some extent. | 0:08:06 | 0:08:09 | |
One of the ironies of medicine is a lot of medicine is an act. | 0:08:09 | 0:08:12 | |
Very early on as a young doctor you learn the patient does not want | 0:08:12 | 0:08:16 | |
the doctor to say, I do not know what to do. | 0:08:16 | 0:08:19 | |
We want our doctors to be experienced and confident. | 0:08:19 | 0:08:22 | |
In my case, that is easy, because I am. | 0:08:22 | 0:08:24 | |
But younger doctors are not. | 0:08:24 | 0:08:25 | |
If you do not take on the difficult cases, how will you get better? | 0:08:25 | 0:08:29 | |
You face an ethical problem from the moment you become a doctor, | 0:08:29 | 0:08:33 | |
you have to start lying to patients. | 0:08:33 | 0:08:34 | |
You have to pretend you are confident. | 0:08:34 | 0:08:36 | |
You must deceive other people in order to deceive yourself. | 0:08:36 | 0:08:39 | |
It is a necessary self-deception to help one cope. | 0:08:39 | 0:08:41 | |
It is not a bad thing. | 0:08:42 | 0:08:43 | |
As you get older, you can try to dispense with some of it | 0:08:43 | 0:08:47 | |
and treat patients more as equals. | 0:08:47 | 0:08:48 | |
I wondered with that incident and others like it, | 0:08:56 | 0:08:59 | |
you are very honest, you went to a hospital that | 0:08:59 | 0:09:01 | |
specialised in long-term care. | 0:09:01 | 0:09:06 | |
I saw that patient years later. | 0:09:06 | 0:09:08 | |
You operated on people who were in essence brain damaged. | 0:09:08 | 0:09:10 | |
I wonder what threshold of risk you are prepared to take | 0:09:10 | 0:09:13 | |
changed over time? | 0:09:13 | 0:09:18 | |
It goes up and down, is the answer. | 0:09:18 | 0:09:28 | |
After the case you mentioned, I became over conservative. | 0:09:28 | 0:09:38 | |
But it again reflected the working environment I was in 25 years ago. | 0:09:38 | 0:09:42 | |
Over the years, I discovered the way to do really difficult cases, | 0:09:42 | 0:09:45 | |
they are very rare, so you only see a handful. | 0:09:45 | 0:09:48 | |
When I was working in Nepal recently we had a couple of cases like that. | 0:09:48 | 0:09:52 | |
My colleague was on his own, he runs his own hospital. | 0:09:52 | 0:09:55 | |
My colleague said, how wonderful of you to share an operation. | 0:09:55 | 0:09:59 | |
A more collaborative way of working is very important in modern surgery. | 0:09:59 | 0:10:05 | |
A thought, I wonder if it is more difficult to take on the risk | 0:10:05 | 0:10:09 | |
of a very difficult operation which you know has a serious risk | 0:10:09 | 0:10:12 | |
of sometimes catastrophic consequences. | 0:10:12 | 0:10:26 | |
But whether it is more difficult to tell a patient who is desperate | 0:10:26 | 0:10:30 | |
for you, even though you have explained all of the risks, | 0:10:30 | 0:10:33 | |
that it is not the right decision and it is right for nature | 0:10:33 | 0:10:36 | |
to take its course. | 0:10:36 | 0:10:37 | |
And you feel there is nothing more you can do for them. | 0:10:37 | 0:10:41 | |
Which is harder? | 0:10:41 | 0:10:42 | |
It depends on the nature of the problem. | 0:10:42 | 0:10:44 | |
I think it is harder to do nothing. | 0:10:44 | 0:10:46 | |
Do you? | 0:10:46 | 0:10:46 | |
It is harder to say, go away and die. | 0:10:46 | 0:10:49 | |
That is very difficult. | 0:10:49 | 0:10:50 | |
Sometimes you say it is the better outcome. | 0:10:50 | 0:10:54 | |
Yes, you learn with experience. | 0:10:54 | 0:10:55 | |
I see my younger colleagues operating on cases which I did | 0:10:55 | 0:10:58 | |
at that stage of my career which now I wouldn't. | 0:10:58 | 0:11:05 | |
I no longer do emergency work, but when I was I was often | 0:11:05 | 0:11:08 | |
called about emergencies. | 0:11:08 | 0:11:13 | |
Emergency neurosurgery is actually very simple. | 0:11:13 | 0:11:21 | |
It's not the lazy consultant refusing to get out of bed. | 0:11:21 | 0:11:24 | |
The actual operating is very easy. | 0:11:24 | 0:11:25 | |
It is based on moving blood clots. | 0:11:25 | 0:11:27 | |
But the decision on whether it is worth operating is very difficult. | 0:11:27 | 0:11:31 | |
You have strokes where if you do not operate they will die. | 0:11:31 | 0:11:34 | |
If you do operate, they may survive, but they might be left disabled. | 0:11:34 | 0:11:37 | |
It's like the Roman games, If I say, thumbs up, | 0:11:37 | 0:11:40 | |
operate, I get back to sleep. | 0:11:40 | 0:11:42 | |
If I say thumbs down, I do not. | 0:11:42 | 0:11:44 | |
There's a symmetry. | 0:11:44 | 0:11:54 | |
Is it important for you to get to know your patience before operating? | 0:11:54 | 0:12:01 | |
I used to think it was. | 0:12:01 | 0:12:03 | |
My son had a brain tumour when he was very young. | 0:12:03 | 0:12:06 | |
He was a few months old. | 0:12:06 | 0:12:11 | |
I was doing general surgery. | 0:12:11 | 0:12:12 | |
That is not why I became a brain surgeon myself. | 0:12:12 | 0:12:20 | |
It gave me a certain understanding and sympathy of what my patients | 0:12:20 | 0:12:23 | |
were going through. | 0:12:23 | 0:12:27 | |
They say an essential part of the operating was to be quite | 0:12:27 | 0:12:30 | |
close to the patients and their families. | 0:12:30 | 0:12:48 | |
That is partly selfish. | 0:12:48 | 0:12:48 | |
If you are close to them and things go wrong, | 0:12:48 | 0:12:51 | |
they are less likely to lose trust in you. | 0:12:51 | 0:12:54 | |
It is selfish and not selfish because you are more invested | 0:12:54 | 0:12:57 | |
in the case emotionally. | 0:12:57 | 0:13:02 | |
In Nepal my colleague and his team were doing all the talking | 0:13:02 | 0:13:05 | |
because of the language barrier. | 0:13:06 | 0:13:08 | |
I was operating on patients I hadn't seen before | 0:13:08 | 0:13:10 | |
and would scarcely see after. | 0:13:11 | 0:13:12 | |
In the past it would have been complete anathema. | 0:13:12 | 0:13:15 | |
It did not make a difference. | 0:13:15 | 0:13:16 | |
I was just as focused and intense about the operating. | 0:13:16 | 0:13:19 | |
That was a surprise to me. | 0:13:19 | 0:13:21 | |
I was better than I expected. | 0:13:21 | 0:13:30 | |
Let me switch focus and talk to you about this most amazing | 0:13:30 | 0:13:33 | |
organ of ours. | 0:13:33 | 0:13:34 | |
It is so complex, it is so mysterious in many ways. | 0:13:34 | 0:13:37 | |
And yet you approach it with sometimes drills, | 0:13:37 | 0:13:39 | |
saws, knives and suckers and there is something quite | 0:13:39 | 0:13:42 | |
bizarre about that. | 0:13:42 | 0:13:48 | |
And yet you approach it with sometimes drills, saws, | 0:13:48 | 0:13:50 | |
knives and suckers and there is something quite bizarre about that. | 0:13:50 | 0:13:54 | |
It is utterly bizarre. | 0:13:54 | 0:13:56 | |
It is something, in a sense, when I was younger, I rather took for | 0:13:56 | 0:14:00 | |
granted but, for various reasons, as I get older, I am more and more | 0:14:00 | 0:14:11 | |
amazed by this fundamental mystery. | 0:14:11 | 0:14:13 | |
Everything you and I are thinking and feeling at | 0:14:13 | 0:14:15 | |
the moment is electricochemistry. | 0:14:15 | 0:14:16 | |
It doesn't feel like electricochemistry. | 0:14:16 | 0:14:17 | |
It feels free and insubstantial but we are the product of the electrical | 0:14:17 | 0:14:21 | |
chemical activity of nerve cells. | 0:14:21 | 0:14:22 | |
And although I'm a complete believr in science with | 0:14:22 | 0:14:25 | |
a capital "S," what is fascinating is that modern science... | 0:14:25 | 0:14:28 | |
we cannot even begin to explain how thoughts and feelings, | 0:14:28 | 0:14:30 | |
our consciousness arises We just do not know... | 0:14:30 | 0:14:38 | |
Your career has spanned 35 years or so, in brains - are you saying | 0:14:38 | 0:14:42 | |
to me that in those 35 years you have learnt very little more about | 0:14:42 | 0:14:46 | |
how the electrochemistry works? | 0:14:46 | 0:14:47 | |
Yes. | 0:14:47 | 0:14:47 | |
How thought, consciousness... | 0:14:47 | 0:14:50 | |
We know how a brick is made but it is not tell us anything | 0:14:50 | 0:14:53 | |
about the house made by the bricks. | 0:14:53 | 0:14:55 | |
So although there's a huge amount of neuroscience going on, | 0:14:55 | 0:14:58 | |
what really interests us as human beings is ourselves, | 0:14:58 | 0:15:00 | |
our feelings and consciousness. | 0:15:01 | 0:15:02 | |
You can't experiment on it, you see, either. | 0:15:02 | 0:15:04 | |
You write lyrically about this. | 0:15:04 | 0:15:09 | |
At one point you write about being struck, during | 0:15:09 | 0:15:12 | |
an operation, that your sucker, as you call it, your kind of Hoover | 0:15:12 | 0:15:15 | |
thing that you suck jelly out of... | 0:15:15 | 0:15:17 | |
You say, "my sucker is moving through thought | 0:15:17 | 0:15:19 | |
itself, through emotion and that reason, memories and dreams | 0:15:19 | 0:15:22 | |
should consist of this jelly is simply too strange to understand." | 0:15:22 | 0:15:26 | |
It is the last great...the great mystery. | 0:15:27 | 0:15:29 | |
My question is, how dare, how, literally, dare you suck out all | 0:15:29 | 0:15:32 | |
of this jelly when you might be sucking out people's imaginations | 0:15:32 | 0:15:35 | |
or thoughts or dreams! | 0:15:35 | 0:15:37 | |
Well, the answer to that is the illness | 0:15:38 | 0:15:43 | |
you're trying to treat is even worse than the operation, so to speak. | 0:15:43 | 0:15:46 | |
I mean, coming back to the question, how do surgeons cope with | 0:15:47 | 0:15:50 | |
their bad results and complication? | 0:15:50 | 0:15:51 | |
Well, you think of the good results and you know that | 0:15:51 | 0:15:54 | |
most of the time things go well. | 0:15:54 | 0:15:57 | |
For all the poor patients who have not done well in my hands, | 0:15:57 | 0:16:00 | |
there are, hopefully, made hundreds or even thousands who have. | 0:16:00 | 0:16:03 | |
I think we know that's true. | 0:16:03 | 0:16:05 | |
That is what ultimately the balance is about. | 0:16:05 | 0:16:07 | |
Sure. | 0:16:07 | 0:16:08 | |
But it is terribly important...maybe | 0:16:08 | 0:16:09 | |
it's partly my personality.. | 0:16:10 | 0:16:11 | |
But, you know, success is corrupting. | 0:16:11 | 0:16:12 | |
Success makes us complacent and spoils us. | 0:16:12 | 0:16:16 | |
The worse surgical crime, for me, is complacency. | 0:16:16 | 0:16:20 | |
I'm not saying...you | 0:16:20 | 0:16:22 | |
mustn't dwell constantly on your complications - | 0:16:22 | 0:16:24 | |
you must never forget them. | 0:16:24 | 0:16:25 | |
You tend to forget them but it is terribly important to | 0:16:25 | 0:16:28 | |
remain as humble and modest as you can even though you must | 0:16:28 | 0:16:31 | |
present a more confident and assured outside to the patient. | 0:16:31 | 0:16:34 | |
Before we get back to practical matters of health care, | 0:16:34 | 0:16:37 | |
one more question on the more philosophical side of what you do. | 0:16:37 | 0:16:41 | |
You just said to me, "I'm a scientist. | 0:16:41 | 0:16:43 | |
I believe in science with a capital S." | 0:16:43 | 0:16:46 | |
But you know, for centuries, philosophers and scientific thinkers | 0:16:46 | 0:16:48 | |
have posited the notion that, it the end, our mind, our soul, maybe, is | 0:16:49 | 0:16:52 | |
separate from the physical reality of this thing between our ears. | 0:16:52 | 0:16:57 | |
Are you telling me you absolutely are convinced there is no | 0:16:57 | 0:17:00 | |
possibility of that being true? | 0:17:00 | 0:17:06 | |
I think it is highly unlikely. | 0:17:06 | 0:17:10 | |
(LAUGH). | 0:17:10 | 0:17:11 | |
One way to put it. | 0:17:11 | 0:17:12 | |
Deeply improbable. | 0:17:13 | 0:17:14 | |
The brain is everything. | 0:17:14 | 0:17:16 | |
We do not understand how it works and maybe we never will. | 0:17:16 | 0:17:21 | |
I find that infinite mystery actually reassuring. | 0:17:21 | 0:17:23 | |
We all know the macrocosm of the big bang - all this stuff | 0:17:23 | 0:17:27 | |
recently about the anniversary of Einstein's general relativity. | 0:17:27 | 0:17:30 | |
Each of us, with our own head, our own consciousness, is sitting on | 0:17:30 | 0:17:34 | |
a mystery as great as the big bang. | 0:17:34 | 0:17:36 | |
So...I'm | 0:17:36 | 0:17:36 | |
sure you have read the science papers that address | 0:17:36 | 0:17:40 | |
near-death experiences and the notion that people credibly | 0:17:40 | 0:17:42 | |
and under scientific conditions can recollect experiences they've had | 0:17:42 | 0:17:46 | |
when normally the machinery has told us that they are brain dead. | 0:17:46 | 0:17:49 | |
But you think it is a mirage? | 0:17:49 | 0:17:51 | |
It is a complicated area. | 0:17:51 | 0:17:55 | |
Brain-dead is rather different. | 0:17:55 | 0:17:57 | |
Near-death experiences are a well recognised phenomenon ...pfft... | 0:17:57 | 0:18:02 | |
But they come out of... | 0:18:02 | 0:18:04 | |
CROSSTALK. | 0:18:04 | 0:18:08 | |
Back to healthcare. | 0:18:08 | 0:18:11 | |
We have talked about you as an individual doctor, | 0:18:11 | 0:18:13 | |
surgeon and how you have approached a career dealing with the most | 0:18:13 | 0:18:18 | |
terrible challenges in the brain. | 0:18:18 | 0:18:20 | |
That's one part of what you do. | 0:18:20 | 0:18:23 | |
Another part of what you've done for years is exist within a vast | 0:18:23 | 0:18:26 | |
health-care system, beeing one small cog component in a huge machine. | 0:18:26 | 0:18:29 | |
It seems to me you have become disillusioned with that machine? | 0:18:29 | 0:18:32 | |
Yes and no. | 0:18:33 | 0:18:37 | |
You have to look at the NHS internationally, | 0:18:37 | 0:18:41 | |
firstly and if you look... | 0:18:41 | 0:18:44 | |
CROSSTALK | 0:18:44 | 0:18:46 | |
There is a lot of criticism in England about the NHS. | 0:18:46 | 0:18:49 | |
You can't read the newspapers without them saying, you know | 0:18:49 | 0:18:53 | |
some mistake in a hospital. | 0:18:53 | 0:18:54 | |
And the headlines say, "Shame the NHS." | 0:18:54 | 0:18:56 | |
That it's the responsibility of the NHS. | 0:18:56 | 0:19:00 | |
The National Health Service provides, | 0:19:00 | 0:19:01 | |
by international standards, very good healthcare in terms of overall | 0:19:01 | 0:19:05 | |
outcomes in life expectancy... | 0:19:05 | 0:19:08 | |
The Americans would call it socialist healthcare... | 0:19:08 | 0:19:10 | |
Passionate! | 0:19:10 | 0:19:12 | |
Passionate in socialized healthcare. | 0:19:12 | 0:19:13 | |
I have worked and visited so many countries where medicine is | 0:19:13 | 0:19:16 | |
commercial and it is terrible... | 0:19:16 | 0:19:19 | |
It is not if you can pay for it. | 0:19:19 | 0:19:21 | |
It comes back to the fact that medicine is not like going | 0:19:22 | 0:19:26 | |
into a shop and buying something. | 0:19:26 | 0:19:27 | |
The patients, A, are not in a good position to judge | 0:19:27 | 0:19:30 | |
what's good for them. | 0:19:30 | 0:19:32 | |
B, a lot of the decision-making is very unclear and very grey. | 0:19:32 | 0:19:36 | |
If you look at countries like America - sure, | 0:19:36 | 0:19:38 | |
at its best it is fantastic - but it is incredibly extravagant. | 0:19:38 | 0:19:41 | |
In all countries, healthcare costs are rocketing | 0:19:41 | 0:19:43 | |
above the rate of inflation. | 0:19:43 | 0:19:45 | |
I'm afraid if doctors have a financial interest in what they | 0:19:45 | 0:19:48 | |
are doing, they tend to do more and a lot of it is unnecessary. | 0:19:48 | 0:19:54 | |
Taking British case of a socialised system which is free | 0:19:54 | 0:19:56 | |
at the point of delivery, politicians have to be more honest | 0:19:57 | 0:20:00 | |
that at a time of rising healthcare costs and an ageing population, | 0:20:00 | 0:20:03 | |
politicians need to say to people, you can have this system... | 0:20:03 | 0:20:06 | |
..but | 0:20:06 | 0:20:06 | |
you need to pay more. | 0:20:06 | 0:20:07 | |
Pay more tax or accept greater rationing. | 0:20:08 | 0:20:10 | |
Exactly. | 0:20:10 | 0:20:12 | |
It is basic economics. | 0:20:12 | 0:20:16 | |
If you have a good which is free at the point od delivery but is | 0:20:16 | 0:20:20 | |
in scarce supply, you end up with queues. | 0:20:20 | 0:20:22 | |
Having all these targets, introduced by the previous government, | 0:20:22 | 0:20:25 | |
can be counterproductive. | 0:20:25 | 0:20:27 | |
You think queues are OK? | 0:20:27 | 0:20:28 | |
No, I don't think they're OK. | 0:20:29 | 0:20:30 | |
But you have to prioritise and deal with the emergencies first. | 0:20:30 | 0:20:33 | |
If you give equal priority on urgent cases, the emergency work suffers. | 0:20:33 | 0:20:36 | |
A lot of people have made points about the organisation, and you | 0:20:36 | 0:20:41 | |
call it the chaos, in the system. | 0:20:41 | 0:20:42 | |
But it seems to me there's another interesting point about you | 0:20:42 | 0:20:46 | |
and it comes back to the word I used earlier, arrogance. | 0:20:46 | 0:20:48 | |
Yes. | 0:20:48 | 0:20:49 | |
You do not like being told what to do by managers. | 0:20:49 | 0:20:52 | |
Exactly. | 0:20:52 | 0:20:52 | |
You do not like being told to can't wear a tie | 0:20:52 | 0:20:55 | |
or a wristwatch, you get angry that your car park has been taken... | 0:20:55 | 0:20:59 | |
I do not drive a car I ride a bicycle everywhere so I don't | 0:20:59 | 0:21:02 | |
have that particular problem. | 0:21:02 | 0:21:03 | |
You are right. | 0:21:03 | 0:21:05 | |
Some of the reviewers of my book comment on my arrogance | 0:21:05 | 0:21:08 | |
but, again, that criticism is probably fair to some extent but | 0:21:08 | 0:21:12 | |
there is this fundamental tension in medicine what patients want... | 0:21:12 | 0:21:15 | |
They want individual care from a doctor. | 0:21:15 | 0:21:19 | |
They want a sense of personal responsibility from an individual. | 0:21:19 | 0:21:25 | |
As a doctor, most of us have this overwhelming sense of personal | 0:21:25 | 0:21:28 | |
responsibility for our patients and for their lives and their death. | 0:21:28 | 0:21:31 | |
If you are treated as just another minor cog in the machine, | 0:21:31 | 0:21:37 | |
it produces a lot of tension. | 0:21:37 | 0:21:40 | |
Psychologists will say many times one of the most stressful situations | 0:21:40 | 0:21:44 | |
- lab rats or human beings - to have a position | 0:21:44 | 0:21:48 | |
of responsibility with no power. | 0:21:48 | 0:21:49 | |
And that's very stressful. | 0:21:49 | 0:21:51 | |
You have escaped the confines of NHS. | 0:21:51 | 0:21:53 | |
A lot of your work is done abroad abroad - Ukraine, Nepal. | 0:21:53 | 0:21:59 | |
I want to end by asking you this, having worked for | 0:21:59 | 0:22:02 | |
so long with sick people, with terrible health challenges of | 0:22:02 | 0:22:05 | |
the brain, are you now frightened of your brain and deterioration? | 0:22:05 | 0:22:11 | |
Oh, yes, I am. | 0:22:11 | 0:22:13 | |
Most of us have had one or two demented parents to care for. | 0:22:13 | 0:22:18 | |
Dementia is an increasing problem in wealthy countries | 0:22:18 | 0:22:23 | |
and it bothers me greatly. | 0:22:23 | 0:22:26 | |
I much more worried about dementia than dying. | 0:22:26 | 0:22:28 | |
The evidence is fairly clear that keeping busy, physical exercise, | 0:22:28 | 0:22:31 | |
are very important to keep it bay but we cannot keep old age at bay, | 0:22:32 | 0:22:37 | |
ultimately. | 0:22:37 | 0:22:39 | |
You are committed to keeping on doctoring. | 0:22:39 | 0:22:42 | |
You said an ageing doctor is a better doctor because | 0:22:42 | 0:22:45 | |
if the wheels start to fall off you have more empathy. | 0:22:45 | 0:22:48 | |
You are more sympathetic, yes. | 0:22:49 | 0:22:51 | |
Having said that, you need to know when to stop. | 0:22:51 | 0:22:55 | |
Everything in life has a life itself. | 0:22:55 | 0:22:57 | |
Best to leave too early rather than too late. | 0:22:57 | 0:23:00 | |
We began by talking about... | 0:23:00 | 0:23:01 | |
I'm not ready to stop yet.. | 0:23:01 | 0:23:03 | |
We began by talking about whether you wanted an honest doctor | 0:23:03 | 0:23:06 | |
or a doctor with a steady hand. | 0:23:06 | 0:23:07 | |
I mean, I don't wish to be sort of rude but, as you age, as I age, | 0:23:08 | 0:23:12 | |
your hand gets a bit unsteady, your eyesite isn't quite so good. | 0:23:12 | 0:23:15 | |
Do you think about these things? | 0:23:15 | 0:23:17 | |
I have been thinking about it quite a lot when I was | 0:23:17 | 0:23:20 | |
operating in Nepal - I was mainly there to teach but I ended up doing | 0:23:20 | 0:23:24 | |
a lot of major operating, more than I would do in this country, | 0:23:24 | 0:23:28 | |
in fact - and I felt two things. | 0:23:28 | 0:23:30 | |
One, I was pretty sure that purely manually I was as good as I was. | 0:23:30 | 0:23:34 | |
My operating is done with a microscope | 0:23:34 | 0:23:38 | |
so eyesight isn't an issue. | 0:23:38 | 0:23:40 | |
But I felt increasingly ashamed and embarrassed at how crude | 0:23:40 | 0:23:46 | |
the operating I was doing was compared to what I increasingly | 0:23:46 | 0:23:49 | |
understand about the brain. | 0:23:49 | 0:23:51 | |
It's from neuroscience books not from neurosurgical medicine. | 0:23:51 | 0:23:56 | |
That struck me. | 0:23:56 | 0:23:59 | |
I need to gradually withdraw from operating, clearly but not yet. | 0:24:00 | 0:24:03 | |
Not yet, please. | 0:24:03 | 0:24:08 | |
I hope you keep going for quite sometime. | 0:24:08 | 0:24:10 | |
I still totally in love with it. | 0:24:10 | 0:24:12 | |
Dr Henry Marsh, it has been a pleasure. | 0:24:12 | 0:24:14 | |
Thank you. | 0:24:14 | 0:24:15 | |
Thank you very much indeed. | 0:24:15 | 0:24:24 | |
It looks as though Wednesday will start on a cold note for many | 0:24:43 | 0:24:46 | |
parts of the British Isles. | 0:24:46 | 0:24:48 | |
Certainly in England and Wales. | 0:24:48 | 0:24:49 | |
But my major concern is the density of the fog. | 0:24:49 | 0:24:52 | |
Quite a widespread issue as we start the new day. | 0:24:52 | 0:24:55 |