We are not meant to touch hearts. We all have one, but most of us will never see one. The heart surgeon now 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 of a miracle, even if, to some, it is merely 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 are not always 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 ground-breaking risk modelling of pioneering surgeons like 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, Samer Nashef has challenged the medical profession to be more open and more accurate about the success of surgical procedures, for the sake of the patients. In The Naked Surgeon, he unclothes his own profession to demonstrate to his reader (and prospective patient) many revelations, such as the paradox at the heart of the cardiac surgeon’s craft: the more an operation is likely to kill you, the better it is for you. And he does so with absolute clarity, fluency and not a little wit.
‘A superb book for anyone who wants to understand the challenges and complexities of transparency and accountability in the NHS. Told through the eyes of a heart surgeon, it's gripping, honest and numerate — an essential companion in our journey from blind trust in doctors to kind truth.
‘The Naked Surgeon is both is a very important and timely book. Heart surgeon Samer Nashef takes us on a gripping journey from blind trust in surgeons to kind truth. His writing is engagingly honest and numerate, and he is unashamedly open about the risks, benefits and past disasters of his profession, and the importance of focusing on outcomes and knowing where you're heading. Secrecy and cover-up have done huge damage to patients, professionals and the NHS, but the new march to absolute transparency must also be handled with care. Statistics are always simplifications, further distorted in the media, and there is a delicate balance to be had in holding professionals to account and scaring them away from innovation and operating on those who are at highest risk and have most to gain. This book will be vital to anyone who has to weigh up the pros and cons of surgery. And that's most of us, at some stage.’
Dr Phil Hammond
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‘UK consultant cardiac surgeon Samer Nashef joins the swelling ranks of medics who have penned frank inside stories. Piquant detail abounds … but it is Nashef’s long study of risk that injects nuance. It began in 1977, when he discovered that arterial surgeons were responsible for the worst outcomes in a sample of abdominal aortic aneurysm operations. Such failures have, he shows, driven quality measurement in medicine, including his own heart-surgery risk model, EuroSCORE.’
Barbara Kiser, Nature
‘[The Naked Surgeon] takes a Malcolm Gladwell-esque look at what happens in operating theatres … If a book-length examination of the topic sounds dry, it isn't. Nashef’s humanity and compassion shine through.’
‘One can't help but think of Henry Marsh when reading Samer Nashef … Nashef does a fine job of guiding the reader though the surgical and statistical intricacies and he writes clearly, with plentiful moments of humour.’
Peter Forbes, The Independent
‘Bold, brilliant … [The Naked Surgeon explains] why risk-adjusted surgical outcomes, and similar assessment in all specialities, are so important. And it details the many traps that the well-meaning can walk into when compiling or comparing data. Nashef’s writing is lucid, free of medical jargon and, unlike many academic books, it is not dry, being strewn with anecdotes and jokes … An essential book for anyone contemplating surgery, medical treatment, or a career in medicine.’
Leyla Sanai, Independent on Sunday
‘[The Naked Surgeon] takes a scalpel to the medical profession and asks if patients get the standard of care they have the right to expect from their surgeons … A valuable resource.’
Freddie Wood, Irish Independent
‘A readable and generous book.’
Kitty Wheater, Irish Examiner
‘[An] excellent book’
Sathnam Sanghera, The Times