Henry Marsh “Why are Hospitals so often Horrible?”
Our speaker this evening is Henry Marsh one of the UK’s most eminent neurosurgeons. After graduating with a First in PPE, at Oxford he studied Medicine in London, subsequently training as a neurosurgeon.
His work has been the subject of two major BBC documentaries – “Your Life in their Hands” in 2003 and “The English Surgeon” in 2009 which was described in the New York Times as “Enthralling, astonishing…agonizingly human” and in the London Times as “the most moving and honest film about surgery I have ever seen.”.
His book Do No Harm, published in 2014, became an international best seller with more than 30 foreign editions and translations. It has been described as:
“Riveting … extraordinarily intimate, compassionate and sometimes frightening …”
(New York Times)
“Why has no one ever written a book like this before? …what a bloody, splendid book…”
In 2017 he published a second book Admissions, which became a Number 1 Sunday Times best seller and received reviews as enthusiastic as for his first book.
Although retired from full-time work in the NHS he continues to work in diverse countries such as Ukraine, Nepal, Albania and Pakistan.
He is a passionate defender of the NHS and has a long-standing interest in the influence of the hospital environment on patient health and staff morale. He doesn’t speak too highly of healthcare architects but can only be an ally and a friend when he challenges on patients in NHS hospitals who ‘rarely get peace, rest or quiet and never a good night’s sleep’.
He was made a Commander of the Order of the British Empire by HM the Queen in 2010. A man who talks about stage fright at the start of a case; whose profound quotes on quality of life and death are too many to mention.
Henry Marsh has a passion for healthcare environments, mostly because he has worked in them for over 40 years but also because if he hadn’t have been a doctor he suspects he would have studied architecture.
“Hospitals are places where peace, rest and quiet (all essential to recovery) are impossible.”
He started his neurosurgical career at the Atkinson Morley Hospital which was founded by a philanthropist who had suffered a hospital stay at Charing Cross and been disturbed by the sound of carriages at Trafalgar Square so gave money for the building of a hospital in the leafy suburbs of south London. Now the site of the Atkinson Morley is ‘rich trash housing’ and the patients and staff suffer the unpalatable scale of St George’s Hospital, Tooting.
Henry took us on a rapid journey from the pseudo-science of the ancient Egyptians to the pseudo-science of cryogenics and invited us to consider having our heads stored in dry ice for the future.
In fact medicine is now ‘a secular religion. We want long life rather than eternal life; we fear dementia more than we fear the devil; we fervently exercise rather than pray.’
We now have an insatiable appetite for healthcare. In the USA it will consume 20% of income by 2020 and we spend 26% of the cost in the last year of life.
Both the pyramids and Chartres Cathedral are built expressions of our fear of death. As are Hospitals.
So why are hospitals so horrible?
Hospitals are biological hazard areas; they are full of windowless spaces or high windows; multi bed bays are grotesque.
Who is the client and is he informed?
Take the Aga Khan Hospital in Karachi. Beautiful and aesthetically pleasing because the Aga Khan acted as client. But it doesn’t function as a hospital.
We have an ideological faith in technology and hospitals are becoming so complex they are no longer humane.
The knowledge is there to do better. Take intensive care at the Karolinska (or anywhere) where the sound levels were intolerable and the patients felt as if the nurses were just waiting for you to have a heart attack to spring into action. A project to change the ceiling tiles improved rest and recovery of patients and was shown to reduce readmission rates.
Much of modern medicine is palliative care not cure; it is changing all the time and is technologically complex. In recent times alone stents and statins have made cardiothoracic surgeons redundant. Change is occurring at an unrelenting pace.
So where is the incentive to build a well-designed, sympathetic hospital?
How about the hotel model? That, says Henry, is the ‘peacocks tail of evolutionary theory.’
It is extraordinary how much difference can be made by windows with views and natural light.
And size matters – as a neurosurgeon it makes sense to consider Dunbar’s Number; the size of the human brain correlates to the ideal social group size in which humans function well.
For humans that number is about 150 numbers, reflected apparently by the typical number of Christmas cards or mobile phone contacts lists. Staffs in hospitals need to feel comfortable amongst the team; they need to feel a responsibility for what is happening.
Hospitals need to function more like regiments which generate institutional pride. Good offices and good coffee rooms are important because people need to talk. Surgeons need to learn detachment but not be too detached.
Finally, Henry turned to art with a not very complimentary view of Arts Officers or Arts Committees. His proudest achievements at the end of his career? Placing art on walls in waiting rooms and fighting for 7 years to get a ward balcony turned into a garden. That is how to demonstrate ‘care.’
There was time after Henry finished talking for a few questions. It was noted that he had poked a bit of a stick at healthcare architecture and it was clear that the audience enjoyed the presentation – available on SlideShare.