- Do you reckon that studying different areas to medicine before going to medical school made you a more reflective doctor?
-YES! I think the American system of having medicine as a post-graduate/post-college degree is very good.
-How do you value including non medical areas in the training of a doctor?
-I think experience of life outside medicine - doing non-medical work etc - is better than teaching. I have some doubts about the values of American style “Medical Humanities” as part of undergraduate medical teaching.
- There is a lot in your book about end of life. With all your medical experience, would you be able to define what is "a good death" nowadays?
-There is never a good time to die - it is either too early or too late…
A good death is to die without too many regrets - in other words, a good death is all about how we live our lives while still alive, and what we will feel content about having left behind us.
We should also avoid over-treatment in old age -but getting the balance of probabilities right between the risks and benefits of treatment and the risks and benefits of “ letting nature take its course” is very difficult.
I feel that euthanasia, by which I mean the right of us as patients to decide when to end our lives, not any right of doctors to kill us - even though most of us might back away from it at the end - should be an important part of medical practice.
- If you could go back in time, let's say in a time machine, and meet young Henry Marsh at the beginning of his medical career, what would be your main advice or message to him?
-To sleep on all difficult decisions, to take time, to think slowly.
- You talk a lot about decision taking with the patients and informed consent. Do you think life was easier for patients when we practiced a more paternalistic approach to information? would you change anything in this area?
-I am very much against paternalism but accept that some patients prefer it, but probably a declining number in wealthy countries. I also know that as patients we want guidance, support and advice, not just an abstract and neutral description of options.
- You are incredibly open about your own medical mistakes, something that is not common. In Spain we still live in the times of covering up medical mistakes. Is there an easy way to change this?
-Only by senior doctors setting an example
- Do you think the expectations that the society has from doctors and medicine have changed in the last few decades?
Yes, the media - at least in the UK - are increasingly critical and no longer automatically deferential to doctors
- If you were to start all over again, would you be a neurosurgeon?
-Always difficult to answer. Neurosurgery has changed greatly over the last four decades and I have changed as well. But, allowing for all that, yes. But I doubt if I would go into medicine again given the problems in the world. We should not be spending so much money trying to keep old people ( like myself!) alive for longer and longer - the money should be spent on better parenting and better education - the children are the future…..they are being terribly neglected at the moment
- You mention of your many tricks before surgery to separate the procedure from the patient. Do they really work?
-To some extent, yes. One cannot and should not abolish one’s anxiety completely, but it is important to control it
- You don't seem very fond of having junior doctors around in theatre. Are you popular with them in spite of it?
-No, I hope you are wrong. I greatly value my relationship with my juniors and am very proud of - I am told - having the reputation of being a good trainer. I have kept in touch with many of my former trainees, both here and in the US. My work in Nepal, Ukraine, Albania etc is all about teaching.
- Do you have any peculiar hobbies to put your mind away from work?
-Furniture-making ( and I do most of my building and home improvements myself), bee-keeping. I try to run every day, a total of 40 km or so every week, and do weight exercises etc. It gets more difficult as you get older.
- What do you think medicine will be like in 50 years time?
-I don’t know but the patients will be the same.