Hopkins Surgeon Blasts Healthcare Safety, Ethics

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.

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 This points out the dangerous hierarchy that exists in health care; an outdated model that looks more like 19th century obedience to a master than 21st century collaboration among equals.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.
Marshall Steele MD (9/14/2012 at 2:57 PM)

I don't think that we need sensationalism but I agree that we do need effective thoughful change. Medicine is a calling but has also become a business. Believe me, "Bad Profits" are not a part of the value system of most physicians. Most physicians are good, honorable people but all of us often need to be brought back to our roots and values. Sometimes the pressures we face allow these values to be forgotten. Working with many hospitals I have come to realize 4 things; 1. Change is most effective when physicians lead 2. Experts do things better, faster, cheaper 3. Standardization and systems allow folks to become experts quicker 4. Transparency with data speeds improvement Very few physicians aggregate and share the data with patients on the success of their interventions. None of us would think that a golfer who doesn't keep score is likely to be the best. I didn't read the book but agree with the author that we must keep score and be transparent. Only in this way can we improve and gain the trust of those who entrust their lives to us. If the book results in this behavoir then it will have made a great contribution. However, I have always thought that it is best to appeal to the best in people. I hope that folks don't become defensive about some of the more controversial comments that I see in this article but look for the truth and help make the necessary changes. I encourage the author to do the same. Marshall Steele MD Orthopedics
Reed D Gelzer, MD, MPH (9/14/2012 at 10:21 AM)

Thank you Dr. Makary for what promises to be a groundbreaking book. One question: Isn't it the physician's obligation to assure that the patient's best interests are the primary requirement? Isn't it the definition the social construct of "professional" to put the patient's interests first? Let's not dodge the duty of physicians to police themselves and their brethren and not dump that duty onto others in the name of "consumer empowerment." Physicians have lost substantial credibility as arbiters of patient best interest due to the forces you portray. Physicians' claim to professional status will continue to erode if we fail to act in our patients' best interest which, after all, is our professional duty and therefore in our professional interest as well. Reed D. Gelzer, MD, MPH Advocates for Documentation Integrity and Compliance


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