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  • Profile: Ara Darzi

    Profile: Ara Darzi

    The Sunday Times
    June 29, 2008

    Labour's favourite doctor prescribes strong medicine, but patients and
    his colleagues may not swallow it The surgeon Ara Darzi likes to
    listen to Pink Floyd while he wields his scalpel. After a year-long
    operation, the music stops tomorrow when he publishes a review of the
    NHS that aims to revive the ailing patient on its 60th anniversary.

    One of Gordon Brown's first acts as prime minister was to call on Darzi
    to undertake the task. He was duly ennobled as Lord Darzi of Denham and
    made a health minister. Brown's request `gobsmacked' the 48-year-old
    clinician, but stranger things had happened to Darzi.

    Born in Iraq to Armenian parents and raised in the Russian Orthodox
    faith, he went to a Jewish school before studying medicine in Ireland
    and becoming an internationally renowned pioneer of keyhole surgery in
    London. His robot-assisted techniques have earned him the nickname
    `Robo Doc'.

    His years in Dublin have left him with an Irish lilt that marks his
    affable manner. Courteous, brainy and driven, Darzi has done nothing to
    embarrass his patron, unlike Brown's other coopted `outsiders' such as
    Alan West, the security minister, Mark Malloch Brown, the foreign
    minister, and Digby Jones, the trade minister.

    He achieved heroic status last November by helping to save the life of
    Lord Brennan, a Labour peer, who had a heart seizure after attacking
    the Human Fertilisation and Embryology Bill in the Lords.

    `I could see from the corner of my eye Lord Brennan was not very well,'
    Darzi recalled on Desert Island Discs last week. `He collapsed. You
    just forget where you are. So I started jumping on top of benches and
    ended up doing a mouth-to-mouth and heart massage to see if I couldn't
    get him back.' After several minutes of futile attempts, Darzi called
    for an electric defibrillator (`I used the F-word') and revived
    Brennan. `As I was shocking him I saw the Archbishop of York doing his
    prayers.'

    Darzi continues to perform operations on Fridays and Saturday mornings
    in London: he is honorary consultant surgeon at St Mary's hospital,
    professor of surgery at Imperial College and chair of surgery at the
    Royal Marsden. The rest of the weekend is set aside for his wife Wendy
    and children Freddie and Nina.

    Having left political meetings abruptly when summoned for emergency
    operations, he is clear where his priorities lie. He does a humorous
    impression of aghast expressions in Downing Street when he raced off to
    treat a colleague. `From day one I told them: if one of my patients
    [needs attention], that comes first.'

    Darzi seemed in need of pastoral intercession himself last October when
    the interim report of his NHS review proposed 150 polyclinics or
    `super-surgeries', open all hours and partly run by private enterprise,
    which would bring together family doctors and specialist consultants.
    Amid talk of a mass walkout from the health service and calls for
    Darzi's resignation, fears were raised that the innovation could spell
    the end of small practices run by family doctors, replacing them with a
    wasteful, bureaucratic system.

    The clamour has increased in recent weeks, with the British Medical
    Association's `save our surgeries' campaign raising 1.2m signatures.
    Scaremongering, protested Darzi, who accused doctors of `breaking their
    professional vows' by urging patients to oppose the plan. In last
    week's Sunday Times he singled out some doctors as `laggards', so
    intent on protecting their `professional boundaries' that they
    obstructed new treatments.

    Since Darzi mooted the idea of polyclinics, all 31 London health trusts
    have submitted plans for the super-surgeries.

    Tomorrow's review is expected to guarantee minimum standards of care,
    setting out the rights and responsibilities of patients - although
    plans to force people to lose weight or give up smoking in exchange for
    healthcare have been rejected. Darzi also proposes to give a bigger
    role to nurses.

    Under his slogan `localise where possible, centralise where necessary',
    Darzi believes doctors and nurses must treat patients as customers,
    inviting them to grade the quality of their care so others can shop
    around: `When you go to a restaurant you look at a website and find out
    exactly what people said about that restaurant.'

    He visualises the NHS structured like a pyramid with, at the bottom,
    patients receiving more care in the home - and being allowed to die
    there, if they wish - while the top tier would consist of centres of
    excellence along the lines of the Royal Marsden. Complex surgery and
    critical care for serious illnesses would be provided by big hospitals
    serving a million or more people.

    Critics say aspects of the plan smack of John Major's `patient's
    charter', introduced to little effect in 1991. They also cast doubt on
    Darzi's avowed reluctance to take on a political role (`I had sleepless
    nights thinking about this'), claiming he was used as a pawn by the
    government in the 2004 Hartlepool by-election to reinforce its
    reassurances that the town's University hospital would not be closed.

    His detractors point to a telling remark by Alan Johnson, the health
    secretary, on Brown's appointment of nonpoliticians to his `government
    of all the talents', known by the acronym `goats'. Johnson told The
    Guardian in January: `We don't have a goat problem in this department.
    Our goat is tethered.'

    Darzi was born on May 7, 1960, into a family that had fled to Iraq from
    the genocide of Armenians by Ottoman Turks in 1915. His father's work
    as an engineer, developing power stations, often took the family
    abroad, but Baghdad was then a stable cosmopolitan city in which Saddam
    Hussein had yet to appear.

    Darzi's Jewish school was highly disciplined: `Very academic, not even
    a playground. There was no such thing as sport, really.' At home he
    studied Armenian and served as an altar boy in church. He was expected
    to emulate his father's career, but while in hospital with a
    life-threatening case of meningitis, his doctor planted the idea of
    medicine.

    His parents had friends in Ireland, which they considered safe for his
    studies, so at 17 he was packed off to Dublin: `Rain, cold, miserable.'
    Soon he began to fall in love with the place, visiting little towns in
    a sailing boat and frequenting Durty Nelly's bar in Limerick, which he
    had been told had the most beautiful girls. Friends called him `Dara
    Darcy, the dark Paddy'.

    To his mind there was a curious parallel between the conflicts in
    Ireland and Iraq: `Most of the troubles back in Iraq were between the
    factions of the Shi'ites and the Sunnis. In Ireland, is was between two
    factions of Christians. That had no logic to me. I found that quite
    challenging.'

    As a student at the Royal College of Surgeons, Darzi took to hanging
    around hospitals to see if he could make himself useful and experience
    the reality of being a doctor. After conducting his first appendix
    operation, a year before qualifying, he said: `It was the most exciting
    day of my life.'

    He met Wendy, the Protestant daughter of a dentist, at a college
    function. Their subsequent marriage in 1991 posed interdenominational
    problems: `We had to find a church in Ireland to get married, and also
    to have an Armenian patriarch to come and give us a blessing.'

    Darzi first encountered keyhole surgery in Dublin. `Surgery in those
    days was a big cut - the bigger the cut, the more macho the surgeon
    was.' Enthused by accounts of less invasive techniques, he did his
    first keyhole operation and was struck by the patient's quick recovery
    time. `The same day we had done an open operation on the patient next
    door. It was like chalk and cheese.'

    Moving to England to gain experience, he encountered resistance to
    keyhole surgery from his superior, who pronounced the procedure
    dangerous, until Darzi won him round by conducting an operation with
    him. `Very quickly we realised this was the tip of the iceberg.' The
    medical director of St Mary's hospital was so thrilled by the publicity
    that he offered Darzi a consultancy at the youthful age of 31. The
    student decided to wait until he had qualified a year later.

    Showered with awards, in 2002 he was knighted for services to medicine
    and surgery; in 2003 he became a British citizen.

    Darzi says his review of England's healthcare is like no other,
    incorporating the views of 2,000 medical experts. His watchwords are
    courage, innovation and best practice. `I am a great believer in
    bottom-up. When I want to change something in a ward environment, I go
    and talk to the student nurses on the ward, because they know exactly
    what is happening on the ward.'

    It sounds invigorating, but whether doctors can surmount their `change
    fatigue' and give Darzi a sympathetic hearing seems open to doubt.
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