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naturally include himself, should see their work as “an emotionless, technical exercise, comparable to lifting the bonnet of an automobile and repairing the engine”.

Westaby’s machismo won’t be to everyone’s taste, especially given his habit of prefacing the job titles of female colleagues with the word “lady” – as in “lady radiographer” or “lady professor”. There are, however, at least two pretty big points to be made in his defence.

For one thing, while his swaggering braggadocio can certainly be irritating, it does give the book an unmistakable feeling of authenticity. At the end, he quotes George Orwell saying of autobiographies that “a man who gives a good account of himself is probably lying” – and his own refusal to ingratiate himself with the reader means that we get a wholly believable, if not always edifying, portrait of what it takes to be a successful surgeon.

For another, there’s the uncomfortable sense that much of what he says might well be true. Like his first book Fragile Lives, this one recalls individual operations at some length – often in a way likely to baffle the layman. (“The step that made my adrenalin surge was the dissection of the pulmonary valve root out from the ventricular septum in proximity to one of the main branches of the left coronary artery.”) Its central theme, though, is the damage that the NHS is doing to itself and its patients by adopting attitudes more palatable to modern sensibilities.

The current thinking, for instance, is that one tactic for reducing surgeons’ testosterone levels would be to recruit more introverts. Yet, says Westaby, “we all know that extroverts made heart surgery possible in the first place when the introverts and neurotics were too stressed to continue”. He takes an equally robust line on the idea that surgeons should be more open to self-doubt, arguing that this will only to reduce their effectiveness.

But, as in Fragile Lives, his angriest attacks are on the NHS’s decision to make the death-rates of heart surgeons public. This may sound like giving patients useful information. But though the consequences may have been unintended, they weren’t difficult to foresee: that surgeons would either refuse to operate on the riskiest cases so as not to ruin their stats, or leave the profession.

Meanwhile, GPs have been allowed to abrogate “all responsibility for patients outside daytime working hours and at weekends”, and the deeply unhelpful helpline 111 is staffed “by someone who may have worked in Sainsbury’s last week” reading irrelevant questions. Our cancer survival rates are now behind those of Romania, Turkey and Argentina, with 10,000 more British people dying every year than if we were only average. All in all, it’s time we abandoned “that crass political deception: ‘Our system is the envy of the world’.” “Better healthcare systems,” Westaby concludes heretically, “are not managed by the state.”

After reading The Knife’s Edge, you mightn’t be sure whether you like Stephen Westaby – not, I suspect, that he’d care much. You might even regard him as a dinosaur. But you might also find yourself wondering with some alarm what will happen when the NHS gets its way, and dinosaurs like him are finally extinct.

He thinks a rugby head injury gave him the psychopathic traits a good surgeon needs

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