Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care

by Marty Makary

Overview

New York Times Bestseller

“Every once in a while a book comes along that rocks the foundations of an established order that's seriously in need of being shaken. The modern American hospital is that establishment and Unaccountable is that book.”-Shannon Brownlee, author of Overtreated

Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting.

Over the last ten years, neither error rates nor costs have come down, despite scientific progress and efforts to curb expenses. Why? To patients, the healthcare system is a black box. Doctors and hospitals are unaccountable, and the lack of transparency leaves both bad doctors and systemic flaws unchecked. Patients need to know more of what healthcare workers know, so they can make informed choices. Accountability in healthcare would expose dangerous doctors, reward good performance, and force positive change nationally, using the power of the free market.

Unaccountable is a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system.

Product Details

ISBN-13:	9781608198399
Publisher:	Bloomsbury Publishing
Publication date:	09/18/2012
Sold by:	Barnes & Noble
Format:	eBook
Pages:	256
File size:	4 MB

About the Author

Marty Makary, M.D., M.P.H. is a surgeon at Johns Hopkins Hospital and a professor of Health Policy at the Johns Hopkins School of Public Health. He is an advocate for health care innovation, writing in The Wall Street Journal and USA Today. He has written extensively on organizational culture, the science of measuring quality in medicine, and health care reform. Dr. Makary is principle investigator of a Robert Wood Foundation Grant to lower health care costs in the U.S. by creating physician-endorsed measures of appropriate medical care and directs the national “Improving Wisely” project to reduce waste in medicine. He is the author of the bestselling book Mama Maggie-a book about a Nobel prize nominee, and the forthcoming The Price We Pay. He speaks nationally on disruptive innovation in health care.
Marty Makary, MD is a Johns Hopkins professor and member of the National Academy of Medicine. He is the author of two New York Times bestselling books, Unaccountable and The Price We Pay, winner of the 2020 Business Book of the Year Award. Dr. Makary has written for the Wall Street Journal, the Washington Post, and the New York Times, and he has published more than 250 scientific research articles. He served in leadership at the W.H.O. and has been a visiting professor at 25 medical schools. He lives in Baltimore, Maryland.

Table of Contents

Introduction 1

Part I Some Random Doctor

1 Dr. Hodad and the Raptor 9

2 Danger Zones 21

3 The New York Experiment 35

4 The Supersurgeon and the Shah 49

5 "How I Like to Do It" 57

6 Navigating the System 75

7 Tap the Power of Patient Outcomes 83

Part II The Wild West

8 Impaired Physicians 95

9 Medical Mistakes 113

10 Ask Before You Give 129

11 Eat What You Kill 137

12 The All-American Robot 153

Part III Transparency Time

13 Drivers of Culture 163

14 Healthonomics 181

15 Candid Cameras 193

16 A New Generation for Honest Medicine 201

17 What Accountability Looks Like 209

Conclusion 221

Acknowledgments 225

Notes 227

Index 235

Editorial Reviews

We demand accountability from Wall Street and the White House, yet are shockingly reluctant to demand it from our hospitals, laments Makary, a Johns Hopkins surgeon and professor of health policy, in this urgent call for doctors and hospital administrators to ditch their dangerous culture of secrecy. Lifting the veil on the existing wealth of data from hundreds of hospitals’ rates of infections, surgical complications, and other negative patient outcomes, he argues that making those statistics public would force low performers to fix their problems and compete far more effectively rather than waste money on ad campaigns. Moreover, every patient should routinely be able to see a hospital’s re-admission rate; its surgical or treatment complication rates; its “never happen” events, like surgery on the wrong side of a patient; its safety-survey scores from its own workers; its volume of operations and treatments; and its programs to streamline access to patient records. For a noteworthy example, Makary dishes that one patient boasted that his surgeon operated on President Reagan—but had no clue Reagan suffered from complications caused by an improperly placed central-line for IV fluids and medication. This thought-provoking guide from a leader in the field is a must-read for M.D.s, and an eye-opener for the rest of us. Agent:Glen Hartley, Writer’s Representatives LLC. (Sept.)

Publishers Weekly

"Makary's book makes it perfectly clear that data transparency not only allows people to make informed decisions about their health but also nudges hospitals and physicians to be more vigilant and efficient." ---Booklist

From the Publisher

Practicing surgeon and academic Makary (health policy, Johns Hopkins Univ.) suggests that providing patients with more access to their own medical information, as well as to the volume and safety records of facilities and doctors, would improve the overall quality of health care and save money. Examples from his own practice include dictating notes while patients listen and offering to give them videos of their surgeries. He takes on what he believes is the health-care profession's inept self-regulation, poor communication caused by fear of speaking up, obfuscation of available statistics, and nonprofit hospital CEO compensation. He is convinced that transparency and the resulting peer and economic pressure will drive hospitals and physicians in the direction of safer, more efficient care. He reinforces his points with his own experiences as well as those of other practitioners and information from formal studies. VERDICT A very readable, thought-provoking book that will be of interest to health-care consumers, providers, and legislators. The problems pointed out and the solutions suggested deserve to be part of a national discussion.—Richard Maxwell, Porter Adventist Hosp. Lib., Denver

Library Journal

A searing insider's look at what really goes on behind the scenes at major hospitals and how implementing simple steps toward transparency can empower patients and dramatically improve the culture and safety of health care. Makary, a cancer surgeon and professor of health policy at the Johns Hopkins Bloomberg School of Public Health, states in no uncertain terms that medical errors are a nationwide problem affecting thousands of unwitting patients. Often, hospital management operates on corporate models, pursuing profit over quality, resulting in overprescribed procedures and rushed or sloppy surgeries. Despite efforts to make medical care safer, a quarter of all patients in America are harmed by medical mistakes, a statistic that persists largely due to the "code of silence" that exists among doctors. The author argues that transparency, both within hospital personnel and between hospitals and the public, has the potential to radically decrease instances of preventable errors and to eliminate incompetent doctors. For example, making doctor's notes part of a shareable database of medical records increases accountability and allows patients to make more informed decisions about their health. Similarly, requiring hospitals to tally and share mortality rates for standard surgeries leads to quick improvements in practices. When a hospital's reputation is on the line, and potential patient dollars are at stake, the impetus to improve becomes significant. When New York state tried this tactic using heart-surgery death rates, the result was "big, broad improvements in mortality, statewide. With each passing year of public reporting, the state's average death rate went down." Providing an abundance of hospital-reported data alongside eye-opening anecdotes, Makary gives practical tips on how to navigate the system and receive quality care. However, he insists that without dramatic--though easily implemented--changes, little will improve. A galvanizing book full of shocking truths about the current state of health care.

Kirkus Reviews