Gather initial thoughts and broad opinions about the book.

1. Henry Marsh is unflinchingly honest about his failures, describing the “small cemetery” of disasters every surgeon carries internally. Did you find this level of candor about medical error reassuring or unsettling? How did it affect your perception of the surgical profession?

2. How does this memoir compare to other works by physician-authors you may have read, like Adam Kay’s This is Going to Hurt (2017) or The Man Who Mistook His Wife for a Hat (1985) by Oliver Sacks? 

3. Which of the patient stories left the most lasting impression on you, and why?

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Marsh often struggles to balance the professional need for emotional detachment with his human response to tragedy, like when he weeps in his car after delivering bad news to his patient, David. Think about your own professional life. In what ways do you navigate the line between professional composure and personal feeling?

2. The National Institute for Health and Care Excellence (NICE) committee debates the cost-effectiveness of an expensive drug, forcing Marsh to wonder how one can measure the “utility of hope” (247). Where do you land on the balance between pragmatism and hope when facing difficult circumstances? When is hope a crucial motivator, and when might it become a barrier to accepting reality?

3. Marsh claims that becoming an “anxious and angry relative” (11) during his infant son’s health crisis was a crucial part of his medical education. When have you experienced a situation from a completely different viewpoint that fundamentally changed your understanding of it?

4. What does this memoir suggest about the nature of trust between a patient and a doctor, especially after a bad outcome? Can you relate this to any experiences where your own trust in a professional (medical or otherwise) was tested or changed?

5. Were you surprised by the degree to which bureaucratic hurdles, like the iCLIP computer system or bed shortages, impacted life-or-death situations? Have you encountered situations in your own life where institutional systems either helped or hindered important outcomes?

6. Marsh bluntly states that surgeons often get good at difficult operations by making mistakes and leaving a “trail of injured patients” (210) behind them. What are your thoughts on this difficult truth about how expertise is gained in high-stakes professions? Does this trade-off seem necessary or ethically problematic?

Examine the book’s relevance to societal issues, historical events, or cultural themes.

1. The guide details the immense strain on the UK’s National Health Service (NHS) due to bed shortages and managerial targets. How does the book’s portrayal of a public healthcare system resonate with current conversations about healthcare in your own community or country?

2. What is your reaction to the work of the NICE committee, which uses economic models like Quality-Adjusted Life Years (QALYs) to decide which treatments get funded? Does this systematic approach to rationing healthcare seem fair and logical, or does it overlook essential human elements? What alternatives, if any, could you imagine?

3. Marsh’s pro bono work in post-Soviet Ukraine reveals a starkly different medical world, plagued by corruption, equipment shortages, and institutional decay. What does this contrast between his London hospital and the hospitals in Kyiv reveal about global inequalities in healthcare?

Dive into the book’s structure, characters, themes, and symbolism.

1. The memoir is structured as a series of vignettes, each named after a medical condition, rather than a linear chronology. What effect did this structure have on your reading experience? How did it contribute to the book’s major themes, such as the persistent weight of memory and fallibility?

2. How does Marsh use the recurring symbol of the “surgeon’s cemetery” to explore the theme of owning fallibility and the psychological burden of a surgical career?

3. What is the impact of Marsh’s description of the brain as mere “jelly” that somehow produces consciousness, memory, and identity?

4. How does the author’s narrative voice balance clinical precision with raw, personal emotion? Did you find this blend effective in conveying the realities of neurosurgery?

5. Marsh’s memoir joins a tradition of physician-authors who offer readers personal insight into the medical profession. How does Marsh’s intense focus on individual error and personal shame in Do No Harm compare to Atul Gawande’s The Checklist Manifesto (2009), which emphasizes systemic solutions to prevent error?

6. The Coda, which details the high-stakes operation on Will, structurally mirrors the disastrous surgery from the “Hubris” chapter. What is the literary significance of ending the book with this parallel case? To what extent does the successful, albeit terrifying, outcome for Will demonstrate Marsh’s evolution as a surgeon?

Encourage imaginative and creative connections to the book.

1. Marsh describes the view through his operating microscope as a “magical” world, a sanctuary from the chaos of the hospital. If you could create a similar space of intense focus and refuge in your own life, what would it be and why?

2. Imagine you are tasked with creating a mandatory training seminar for surgeons, replacing the empathy training that Marsh describes as being led by a catering professional. What three essential, non-technical lessons from this book would you make central to your curriculum?

3. If you were adapting a single chapter from Do No Harm into a short film, which story would you choose to tell? Would you focus on a triumph, a tragedy, or an ethical dilemma, and what central message would you want your audience to take away?