Unaccountable
What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
(amazon)Marty Makary, M.D. (View Bio)
Hardcover: Bloomsbury, 2012.
As a busy surgeon who has worked in many of the best hospitals in the nation, Marty Makary 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.
"In organized crime, the principle of omerta prohibits divulging secret information that might incriminate the family. Medicine, too, has a code of silence. It protects incompetent doctors and error-prone hospitals from public exposure. In Unaccountable, Marty Makary offers a searing indictment from the inside, arguing that the modern health-care industry, unlike almost every other, doesn't disclose its performance or pricing practices to the public and keeps under wraps information about mistakes and substandard quality. As a surgeon at Johns Hopkins Medicine in Baltimore and a professor of health policy at Hopkins's Bloomberg School of Health, Dr. Makary isn't just a disgruntled whistleblower. He has seen much of what he writes about—and readily confesses his own complicity over the years in concealing the flaws of medical care from those who stand to lose the most when it goes wrong: patients. In the course of his long career he has encountered all manner of malfeasance…. Routinely, Dr. Makary says, hospitals perform unnecessary surgery and harm patients with costly, preventable complications and infections, with no one the wiser…. Dr. Makary argues that true reform will only come with full disclosure. When hospitals have to provide data, performance gets better." — Laura Landro, The Wall Street 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….. 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
"Practicing surgeon and academic Makary 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…. 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. 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." — Library Journal
"Sobering, thought-provoking and wonderfully entertaining, Unaccountable is also very controversial. Using his own experiences and observations as examples for his ideas, Makary sharply illustrates how bad medicine can have tragic outcomes and what can be done about it. Readers will surely be shocked—and frustrated because of the code of silence that Makary describes in dismaying detail and because he offers ample reasons behind why the cost of getting you healthy will make you absolutely sick." — Terri Schlichenmeyer, Inland Empire
"Makary's diagnosis is dangerous, damaging secrecy; his therapy is radical transparency.... His argument is powerful." — Trine Tsouderos, Chicago Tribune
"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." — Tony Miksanek, Booklist
"An eye-opening look at the culture of medicine. And it’s not pretty." — Libby Lewis, CNN
"I’ve never been so petrified of entering a hospital or a doctor’s office as I am now, since reading the excoriating book, Unaccountable. I think anyone who reads it, providers and consumers of healthcare alike, will be too. A Johns Hopkins pancreatic cancer surgeon, Makary portrays an industry operated by a money-grubbing, deceitful, and dangerous cabal of over-worked, sometimes drug-addicted, charlatans who frequently profit from unnecessary and unsafe procedures, and commit malpractice even as they hide behind their mistakes." — Cheryl Clark, Health Leaders Media
"Unaccountable is a gripping story about what's wrong with the American healthcare system and what we might do to make it better" — Peter Pronovost M.D., Ph.D., Executive Vice-President, Johns Hopkins Hospital
"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." — Publishers Weekly
