Hopkins Surgeon Blasts Healthcare Safety, Ethics

Cheryl Clark, for HealthLeaders Media , September 13, 2012

He was further prompted to write the book, he explains, by the healthcare reform bill debates, because absent from the discussion was the imperative to "empower patients to make informed decisions, just like we do for consumers for other goods and services."

With an insider's perspective, Makary paints a picture of a secret society, zealously unwilling to be transparent and whose members are unaccountable to anyone but themselves, and certainly not their peers, regulators, payers, or their patients.

The breadth of the issue is such that many hospitals have started to ask their own employees whether they would dare undergo treatment in their own units, and whether their organization's doctors and nurses "do what's in the best interests of their patients," he says.

At about half of the hospitals where at least 70% of the employees participated in the survey, fewer than half answered yes. Scary.

"I am often bewildered at the ethics of a corporation that is aware of a dangerous product, yet continues to sell it," he writes in the book.

While most of Makary's book focuses on perverse incentives in healthcare, and how they influence quality. But, good things are happening in isolated pockets.

He writes that groups are developing quality metrics that rate how hospitals perform, often with real-time data, but the industry needs to figure out how to best use the information for consumers and providers to see how they're doing.

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5 comments on "Hopkins Surgeon Blasts Healthcare Safety, Ethics"

TTGoodell,RN,PhD (9/20/2012 at 6:56 PM)
I've been an ICU nurse for 30 years. In this time, I've been scolded and even administratively warned for criticizing poor physician practices (and I've seen it happen to others). Docs are still seen, as Makary seems to being saying, as moneymakers and therefore beyond the reach of all criticism. On the other hand, docs are quite free to excoriate nursing practice if they don't like it, right or wrong. This points out the dangerous hierarchy that exists in health care; an outdated model that looks more like 19th century obedience to a master than 21st century collaboration among equals.

Fred Shield, M.D. (9/18/2012 at 3:53 AM)
"In the excoriating book, Unaccountable, Martin A. Makary, MD, portrays a healthcare industry operated by a deceitful and dangerous cabal of over-worked charlatans who frequently profit from unnecessary and unsafe medical procedures." This sounds like a commentary from an arrogant and elitist physician that needs a few more years to mellow and get in touch with reality. How long has he actually practiced, what with all the political and TV time he seems to spend. I invite him to spend two days in my semi-rural hospital and see if he comes away with the same attitude.

Linda Galindo (9/17/2012 at 3:29 PM)
Thank you Dr. Makary. Finally the truth of the matter out there in even plainer terms. I teach the implementation of a mindset of personal accountability in healthcare cultures and its relationship to patient safety and quality care, but the number one comment I get when pulled aside by audience members (usually nurses) is that "the hospital culture will not allow them to hold physicians or even each other accountable!" It's nuts and dangerous and everyone KNOWS that not holding the under performer or uncooperative accountable because they admit the most patients is punishing the best performers. Physicians do not need to get their MBA's to learn to lead in this environment, they have to do the harder thing and introspect and admit their role in the current culture which is "not being accountable gets rewarded MORE than being accountable." It is not "just a few bad apples." Every doc regardless of status who talks ABOUT, but not directly TO, the offenders is complicit. The more they leave it up "to others" to clean up the healthcare culture the more rules, regulations and attempts to control they are inviting. The lower the personal accountability in a population the more victims and need for rules and laws that end up punishing the rest of the support system in place for patients. Thanks again Dr. Makary, it's exactly what's needed. The Straight Truth.




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