The Naked Surgeon

The Power and Peril of Transparency in Medicine
Samer Nashef

We are not meant to touch hearts.

We all have one; but most of us will never see one. The heart surgeon has that privilege, but for centuries, the heart was out of reach even for surgeons. So when a surgeon nowadays opens up a ribcage and mends a heart, it remains something like a miracle, even if it has to come to seem nearly as normal as plumbing.

As with plumbers, the quality of surgeons’ work varies. As with plumbers, surgeons’ opinion of their own prowess and their own attitude to risk is not always entirely reliable. Measurement is key. We’ve had a century of effective evidence-based medicine. We’ve had barely a decade of thorough monitoring of clinical outcomes. Thanks to the groundbreaking risk modelling of pioneering surgeons such as Samer Nashef, we at last know how to judge whether an operation is in a patient’s best interest, which hospital and surgeon would be best for that operation, when it might best be performed and what the exact level of risk is. We have at last made what is important in surgery measurable. But how should surgeons, and their patients, use these newfound insights?

Ever since his days as a medical student, Nashef has challenged his profession to be more open and more accurate about outcomes and variabilities in its surgical procedures, for the sake of its patients. In The Naked Surgeon he unclothes the profession to demonstrate to his reader (and prospective patient) the paradoxes at the heart of the surgeon’s craft: how anaesthetists seem to make no difference to the outcome of an operation, although surgeons do; why patients operated the day before a surgeon goes on holiday are twice as likely to die than those operated on that surgeon's first day back from holiday; why the unexpected death of a low-risk patient during an operation does not impair a surgeon's performance immediately afterwards; and how one surgeon can appear to be better than another by actually killing more patients.

The result is an unprecedented and often controversial insider’s view of medicine that not only explores how doctors and surgeons work and think, but also reveals counterintuitive ideas and eye-opening discoveries that have done more to improve healthcare in the past decade than any new drugs or procedures.