Foreword

I had the pleasure of being a colleague of Samer Nashef after his appointment as a consultant at Papworth Hospital in 1992. It soon became apparent that we had added an unusually gifted and stimulating surgeon to our team. He already had a wide experience across the field of adult cardiac surgery, and was a fine technical surgeon and wise clinician. He also had the habit of questioning received wisdom, which encouraged us to look critically at procedures and see how these could be improved.

In due course, the latter propensity became a driving ambition to help cardiac surgeons to become more transparent about their results. This in turn led to creating the EuroSCORE model for predicting the outcome of heart operations, so that individual and national groups of surgeons could compare their results. The model became widely applied across Europe and beyond, and acted as an important stimulus for improving the results of cardiac surgery, thereby saving many lives.

Nashef’s book gives interesting examples of his investigations into factors affecting outcomes, such as whether surgeons should operate immediately after a death on the table, and whether the risk-propensity of individual surgeons is measurable and can affect their results. He has a gift for making complex issues understandable, and presents the means by which patients can use mortality data to help them come to informed decisions about the risks and benefits of treatments offered them. At a more general level, he provides powerful arguments against some of the ill-conceived targets and rankings created by non-professionals that hospitals have been subjected to, and shows how these can mislead patients and demoralise doctors.

The Naked Surgeon is altogether a very stimulating read and one that will be of great interest to both patients and doctors. It should also receive the attention it deserves from health politicians, hospital managers, and health economists.

Sir Terence English, KBE, FRCS, FRCP
Past President of the Royal College of Surgeons of England