Nancy Foster, Vice President for Quality and Patient Safety for the American Hospital Association, hadn't finished the book when I asked her to comment. But she agrees with its theme, that hospitals have tough problems, and that "clinicians' openness about the issues they perceive is important to solving safety problems."
Foster says, however, that hospitals struggle with a tough challenge, which is getting the right culture for their organizations. Even in other fields, she says, executives have to "work hard to communicate their desire for a safety culture and create the opportunity for it to exist.
Makary tells me he sees glimmers of hope, but also obstructions that need to be overcome. For example, The American College of Surgeons and the Society of Thoracic Surgeons, laudably, have started to collect patient procedure outcomes in national registries. But that's for physicians and hospitals, "not for the public," Makary says.
"The data is locked and sealed tighter than Fort Knox. Hospitals don't want [patients] to see it. In hospital-speak, we call it 'sensitive data,' available only with hospital names removed."
That's a shame, he says. Because some hospitals, even among the most prestigious, have complication rates four to five times those at other hospitals, even after adjusting for patient disease severity, he says.
Of course, what Makary says isn't all that new. As he points out, scholarly articles document harm in roughly one in four patients due to medical mistakes. We know this from recent reports issued by the Institute of Medicine, the Office of Inspector General, and the New England Journal of Medicine.
What we don't know is which doctors and hospital teams are causing them. And that's what Makary wants to find out.