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The Naked Surgeon: the power and peril of transparency in medicine
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 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.
PRAISE FOR SAMER NASHEF
‘[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.’ The Times
‘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.’ The Independent
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 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.
PRAISE FOR SAMER NASHEF
‘[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.’ The Times
‘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.’ The Independent
224 pages, Kindle Edition
First published June 4, 2015
23 people are currently reading
344 people want to read
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Displaying 1 - 24 of 24 reviews
June 15, 2021
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June 8, 2018Sam Nashef's brief and absorbing account of the development of safer outcomes in cardiac surgery is a valuable insight into the mindset of all surgeons. The book places in context important episodes in the development of cardiac surgery and describes the process of driving down mortality rates within a specialty that was initially very dangerous but has now become very safe.‘This book is a must read for all surgeons at any stage in their careers but more importantly the book should be mandatory reading for those that would try to understand the inner workings of the surgical mind. Here I would include particularly anaesthetists, operating theatre staff, surgical nurses, surgical managers and all surgical patients past, present and future.
Steve Bolsin
A superb book for anyone who wants to understand the challenges and complexities of transparency and accountability in the NHS. Told through the eyes and is 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
[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.
The Times
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
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 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
Steve Bolsin
A superb book for anyone who wants to understand the challenges and complexities of transparency and accountability in the NHS. Told through the eyes and is 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
[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.
The Times
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
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 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
April 19, 2025
The Naked Surgeon has been amongst my favourite reads so far in the medical genre. I found this book insightful not only into the world of surgery, but also into medical statistics and the importance of reporting and quality control to drive development and improve efficacy in any field.
I would describe this book as statistics-focused and technical at times yet accessible to non-experts such as myself. After an introduction to statistics in A-Level Maths, learning of its application in medicine was certainly enlightening and highly interesting to read about.
I also enjoyed Nashef’s illumination of his own role in the development of EuroSCORE - a risk model used worldwide to calculate predicted mortality rates for heart operations. Aside from that, throughout the book the author delves into both the positive and negative impacts of quality assurance in the medical field (despite the assumption I took that there would only be positives).
One of my unexpected takeaways from this book is that there are benefits of reporting and reflecting on near misses as well as failures - a process which should seem like common sense but is also something we often fail to consider.
The key message of The Naked Surgeon is the importance of approaching statistics with caution and a critical eye due to the widespread presence of misrepresentation in the media for sensationalism and ‘shock value’. More commonly than you would think, surprising statistics on the news are ones which have been manipulated to put forward a certain narrative and generate assumptions - so it is always essential to look at multiple reliable sources to stray away from the dangers of being misinformed.
4.5 stars
I would describe this book as statistics-focused and technical at times yet accessible to non-experts such as myself. After an introduction to statistics in A-Level Maths, learning of its application in medicine was certainly enlightening and highly interesting to read about.
I also enjoyed Nashef’s illumination of his own role in the development of EuroSCORE - a risk model used worldwide to calculate predicted mortality rates for heart operations. Aside from that, throughout the book the author delves into both the positive and negative impacts of quality assurance in the medical field (despite the assumption I took that there would only be positives).
One of my unexpected takeaways from this book is that there are benefits of reporting and reflecting on near misses as well as failures - a process which should seem like common sense but is also something we often fail to consider.
The key message of The Naked Surgeon is the importance of approaching statistics with caution and a critical eye due to the widespread presence of misrepresentation in the media for sensationalism and ‘shock value’. More commonly than you would think, surprising statistics on the news are ones which have been manipulated to put forward a certain narrative and generate assumptions - so it is always essential to look at multiple reliable sources to stray away from the dangers of being misinformed.
4.5 stars
Want to read
September 28, 2017Putting this on my to-read list because I shook the author's hand once lmao.
May 21, 2019
Brilliant read, one that I’d really recommend. The honesty in which Nashef shows how statistics can be misleading, and how certain individuals / corporations use this to deliberately construe the wrong picture, is a refreshing take on the different ways in which to look at an issue. Not based on a single statistic of course! He brings up issues like surgery categorisation (I never knew there were so many types of bypass surgery!), and how moving things from one to the other can give off a false sense of good outcome which is an angle which never occurred to me previously. One of the last chapters focusing on the actual surgeons, before he goes into policy and the government, describes how things like a table death and having a holiday can impact outcome – and although the narrative is presented in a very logical manner at no point in the book does he come off as arrogant or know-it-all.
There is a good balance between discussion of “things that are wrong with the current system” and “reasons to believe in the current system”, bridged elegantly by “questions you should be thinking about or asking your surgeon”. Nashef goes into some degree of detail into the workings of cardiac surgery (his specialty) but finds an accessible middle-ground that I didn’t get lost in all the description. Being a non-expert I don’t know how far he had to simplify down the explanations in order for it to make that much sense to a layperson, but I thought it helped and made me enjoy the book a bit more as there were technical details mix-and-matched in with more philosophical discussions.
In terms of writing style, Nashef writes like a true scientific writer – where the general rule of thumb is always to keep reminding your audience of the most salient points, because details can often get lost in the big picture if mentioned only once. I know this can come off as repetitive, but it really helped me in that instead of having to flip back to find the exact spot where he’d mentioned a particular point previously, Nashef has a quick reminder sentence right there on the page so I can just continue reading. An enlightening read which gets straight to the point, supports it with examples and cross-references throughout to make it easy to read and follow without necessarily having to hold details in memory. 4.5 stars, 5 on Goodreads.
There is a good balance between discussion of “things that are wrong with the current system” and “reasons to believe in the current system”, bridged elegantly by “questions you should be thinking about or asking your surgeon”. Nashef goes into some degree of detail into the workings of cardiac surgery (his specialty) but finds an accessible middle-ground that I didn’t get lost in all the description. Being a non-expert I don’t know how far he had to simplify down the explanations in order for it to make that much sense to a layperson, but I thought it helped and made me enjoy the book a bit more as there were technical details mix-and-matched in with more philosophical discussions.
In terms of writing style, Nashef writes like a true scientific writer – where the general rule of thumb is always to keep reminding your audience of the most salient points, because details can often get lost in the big picture if mentioned only once. I know this can come off as repetitive, but it really helped me in that instead of having to flip back to find the exact spot where he’d mentioned a particular point previously, Nashef has a quick reminder sentence right there on the page so I can just continue reading. An enlightening read which gets straight to the point, supports it with examples and cross-references throughout to make it easy to read and follow without necessarily having to hold details in memory. 4.5 stars, 5 on Goodreads.
January 11, 2023
Real rating: 3.5 stars
I won't say that this book really liked me because it took me ages to finish it. I think the book it's mainly dedicated to people on the surgical field, even though I'm a medical student I can't give this book more, because it didn't take too long to unveil everything, and so it wasn't that good for me.
In my perspective, the book teaches you and gives you life lessons along with tips to make the right decision based on EuroScore, a system for assessing risks in heart surgery depending on the patient's condition, invented by the author itself along with Dr. François Roques.
You might consider it as a good book if you want to go deep on medical knowledge and to know what's new on the international medical field, or even to find advice to make the right decision when it comes to a high risk surgery or even to make you aware about the defects on the current medical system and how to be prepared when making an error when being involved in such a stressing area like the wonderful medical world.
However, it has its flaws when it comes to describing or narrating stories, there a lot of heavy and hard to understand statistics and very long descriptions to explain an example, that at the end, misses the point on the example and you don't even remember what was the point for bringing that out.
But overall, the book has a very understandable use of words in some chapters, and the author explains everything in a very humble and caring way that connects with you and can give the necessary knowledge whether you are a patient, a relative's patient, a doctor or a future doctor.
I won't say that this book really liked me because it took me ages to finish it. I think the book it's mainly dedicated to people on the surgical field, even though I'm a medical student I can't give this book more, because it didn't take too long to unveil everything, and so it wasn't that good for me.
In my perspective, the book teaches you and gives you life lessons along with tips to make the right decision based on EuroScore, a system for assessing risks in heart surgery depending on the patient's condition, invented by the author itself along with Dr. François Roques.
You might consider it as a good book if you want to go deep on medical knowledge and to know what's new on the international medical field, or even to find advice to make the right decision when it comes to a high risk surgery or even to make you aware about the defects on the current medical system and how to be prepared when making an error when being involved in such a stressing area like the wonderful medical world.
However, it has its flaws when it comes to describing or narrating stories, there a lot of heavy and hard to understand statistics and very long descriptions to explain an example, that at the end, misses the point on the example and you don't even remember what was the point for bringing that out.
But overall, the book has a very understandable use of words in some chapters, and the author explains everything in a very humble and caring way that connects with you and can give the necessary knowledge whether you are a patient, a relative's patient, a doctor or a future doctor.
October 27, 2018
I've read a few books about medicine recently (there's been a spate of them). Henry Marsh's books were the most personal and accessible. This one is a bit more technical and has a fair smattering of statistics. Some of it was a bit nostalgic for me as I was working in the NHS at the time of the dawn of evidence-based medicine, systematic quality improvement and clinical governance. It makes a very strong case for the statistical analysis of outcomes, for challenging received wisdom and for whistleblowing. We see what can go wrong and what did go very wrong in the past but we might be reassured that things are much improved today (overall) ... unless your operation is in the morning and the surgeon is flying off on holiday in the afternoon.
November 6, 2023
This was not what I thought it would be! I was expecting an Adam Kay recount with personal stories, but the book mainly focused on data, analysing information and discussing what information we should be collecting and analysing to begin with. It was incredibly interesting to learn about death rates and rates of "mistakes" in surgery and why (perhaps) they happen. I enjoyed how the book and data were not solely British but international. Sometimes it felt as though the same point was being explained in ten different ways to hammer the point home and that did get annoying. Overall I would absolutely recommend (especially to those medics out there).
March 17, 2020
Surgeons and Statistics
This is an interesting look into how to measure surgical outcomes. What I think of as normal (measured outcomes in the manufacturing world) is still in its infancy in the medical profession.
I heard Samer Nashef give an interview on the radio. He was capturing, interesting and knowledgeable. I wanted to read this book.
I enjoyed the insight into a profession I knew little about.
Three stars.
This is an interesting look into how to measure surgical outcomes. What I think of as normal (measured outcomes in the manufacturing world) is still in its infancy in the medical profession.
I heard Samer Nashef give an interview on the radio. He was capturing, interesting and knowledgeable. I wanted to read this book.
I enjoyed the insight into a profession I knew little about.
Three stars.
January 21, 2018
I was both horrified and intrigued by the description of many surgeons as caring more about pride and their own practices than patient care. It horrified me and it's god that changes have occurred to deal with the high mortality rates. It's always great to see a department strive for self-improvement, especially since this self-improvement saves lives.
January 23, 2018
Nashef did an excellent job of illustrating just have misleading statistics can be if not approached with caution and an eye for critical analysis. In the field of surgery, where statistics can sway the public's perception of healthcare, it is vital that statistical reports are honest and accurate.
December 4, 2021
A valuable insight into workings of a surgeon when dealing with optimal patient care and achieving and maintaining good surgical practice. A helpful guide for a young surgeon as myself starting off on their surgical journey.
November 12, 2022
"This has often been called the cardiac surgical paradox, and it can be stated simply, and brutally, like this: the more the operation is likely to kill you, the better it is for you."
Истината е винаги за предпочитане. Стремежът към съвършенство трябва да бъде постоянен.
Истината е винаги за предпочитане. Стремежът към съвършенство трябва да бъде постоянен.
September 14, 2024
An interesting take on safety in medicine and the evolution of methods to monitor and assess surgical outcomes. Written in an accessible way for lay-people to read but will be more interesting to medical professionals.
December 25, 2025
surprisingly fun read about heart surgery and medicine, as someone who is not in the field whatsoever i felt like i learned quite a bit about the field of surgery in general. though the statistics explanations at the start did make me feel a bit like i was being treated like an idiot.
Read
July 25, 2019Having met Samer Nashef, I have found his books very interesting. He was my husband’s surgeon 4 years ago.
Both of us have been patients at Papworth.
Both of us have been patients at Papworth.
This entire review has been hidden because of spoilers.
January 6, 2021
A must read for all pursuing medicine.
February 2, 2021
Brilliant book. Fascinating, engaging and thorough.
August 7, 2022
A good breakdown of how medical data is twisted by practitioners for their own gain, and misrepresented by the media for sensationalism and shock factor. Also an insight into a bit of heart surgery.
February 18, 2017
This is Surgery Confidential, and it's fascinating. Nashef is clear and accessible on how statistics guide (and mislead) interpretations of "the best." Heart surgery is ground zero for data because it's so common, and the small adjustments (taking a single stitch outside the parameters of a standard procedure in order to bump the possibly high-risk patient out of your numbers and into a category for a slightly more high-risk procedure. . . for example).
Nashe has the greatest respect for the work that surgeons do, and he make the spectacularly high standards in the profession very clear. Constantly under intense scrutiny, beating hearts in their hands (among other body parts), the nerve and finesse (and sometimes coldness) demanded are fascinating.
Nashe has the greatest respect for the work that surgeons do, and he make the spectacularly high standards in the profession very clear. Constantly under intense scrutiny, beating hearts in their hands (among other body parts), the nerve and finesse (and sometimes coldness) demanded are fascinating.
February 21, 2017
Fascinating insight into the world of heart surgeons. The two appendices are quite confronting though as they deal with actual deaths from operations rather than statistical analysis.
February 5, 2017
This book is very, very good. It explains very clearly the pressures cardiac surgeons are under, the difference their temperament or targets can make to their performance and how the profession is now more open and accurate regarding the outcomes of the various procedures they undertake. The author has been tenacious in his pursuit of the truth regarding past failings by cardiac surgeons, repeatedly challenging them to be more accurate in reporting and recording the outcomes of operations. So that now heart surgery is the most monitored of all the medical disciplines. Thank goodness for people like Samer Nashef and Steve Bolsin, two chaps who stuck to their guns to bring the truth of past failings to light, and to vastly improve the outlook for future heart patients.
January 23, 2016
Interesting look at statistical analysis and quality management in heart surgery mainly, but medicine in general. Easy to read though at times it was a bit repetitive as if he didn't trust us to remember things he had written earlier in the book.
December 10, 2015
Brilliant account of how measurements, self-attestation and pursuit for quality can improve whatever we do and our life.
Displaying 1 - 24 of 24 reviews