Reflections on Unaccountable by Dr. Martin Makary
When faced with a new health problem, patients are left in the dark as to where they should turn for their medical care. People often choose doctors and hospitals based on the ease of parking, hospital advertising, friendliness of the reception staff and other metrics that have little or nothing to do with patient safety. Most people are under the illusion that as long as they are being treated by licensed doctors in a hospital in the United States, care is standard across the board. However, if these people could see the actual differences in outcomes from different hospital systems, they would be shocked.
Armed with information about which hospitals are safest and which are the least safe, they could make informed decisions about where to be treated. Additionally, hospitals would compete to be the safest with the best culture. This step could revolutionize healthcare in the United States making it safer and lost costly.
In his new book, Unaccountable, Dr. Martin Makary discusses the lack of transparency in medicine and the radically disparate healthcare in different hospitals. In one example in the book, Dr. Makary and colleagues conducted a national survey regarding teamwork in hospitals. They asked if healthcare workers would want to be treated at their own hospital. They found that in some hospitals, only 18% of healthcare workers would want to be treated in their own facility. Interestingly, this lack of satisfaction was correlated with patient outcomes. Amazingly, none of this information is public.
Wouldn’t you want to know if your grandmother was being treated at the hospital with only an 18% satisfaction rating and worse patient outcomes? However, hospitals have no incentive to publish the information as bad publicity will push patients away and complications make money for hospitals. When New York hospitals were required by the government to report mortality rates after coronary artery bypass procedures, they made radical, swift steps to change as patients stopped going to the poorly performing hospitals. One hospital that had a mortality rate of 18% more than halved it to 7% in one year and subsequently decreased it to less than 2%, the national standard. This is just one of several issues raised in this phenomenal book outlining the urgent need for transparency in medicine, a cause for which I have become very passionate.