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

by Marty Makary, Martin Makary

Overview

“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:	9781608198382
Publisher:	Bloomsbury USA
Publication date:	10/15/2013
Pages:	256
Product dimensions:	5.45(w) x 8.25(h) x 0.70(d)

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 a regular medical commentator for CNN and FOX News, and appears weekly on a wide variety of programs to discuss health topics. He is a leading patient-safety researcher and led the World Health Organization effort to develop ways to measure healthcare quality. He tweets @DrMartyMD. He lives in the Baltimore/DC area.

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