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