Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care

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Overview

“Every once in a while a book comes along that rocks the foundations of an established order that's seriously in need of being shaken. The modern American hospital is that establishment and Unaccountable is that book.”—Shannon Brownlee, author of Overtreated

Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to ...

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Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care

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Overview

“Every once in a while a book comes along that rocks the foundations of an established order that's seriously in need of being shaken. The modern American hospital is that establishment and Unaccountable is that book.”—Shannon Brownlee, author of Overtreated

Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he 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.

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Editorial Reviews

Publishers Weekly
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. Agent:Glen Hartley, Writer’s Representatives LLC. (Sept.)
From the Publisher
"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." —-Booklist
Library Journal
Practicing surgeon and academic Makary (health policy, Johns Hopkins Univ.) 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. Examples from his own practice include dictating notes while patients listen and offering to give them videos of their surgeries. He takes on what he believes is the health-care profession's inept self-regulation, poor communication caused by fear of speaking up, obfuscation of available statistics, and nonprofit hospital CEO compensation. 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. VERDICT 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.—Richard Maxwell, Porter Adventist Hosp. Lib., Denver
Kirkus Reviews
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. Makary, a cancer surgeon and professor of health policy at the Johns Hopkins Bloomberg School of Public Health, states in no uncertain terms that medical errors are a nationwide problem affecting thousands of unwitting patients. Often, hospital management operates on corporate models, pursuing profit over quality, resulting in overprescribed procedures and rushed or sloppy surgeries. Despite efforts to make medical care safer, a quarter of all patients in America are harmed by medical mistakes, a statistic that persists largely due to the "code of silence" that exists among doctors. The author argues that transparency, both within hospital personnel and between hospitals and the public, has the potential to radically decrease instances of preventable errors and to eliminate incompetent doctors. For example, making doctor's notes part of a shareable database of medical records increases accountability and allows patients to make more informed decisions about their health. Similarly, requiring hospitals to tally and share mortality rates for standard surgeries leads to quick improvements in practices. When a hospital's reputation is on the line, and potential patient dollars are at stake, the impetus to improve becomes significant. When New York state tried this tactic using heart-surgery death rates, the result was "big, broad improvements in mortality, statewide. With each passing year of public reporting, the state's average death rate went down." 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.
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Product Details

  • ISBN-13: 9781608198382
  • Publisher: Bloomsbury USA
  • Publication date: 10/15/2013
  • Edition number: 1
  • Pages: 256
  • Sales rank: 107,599
  • Product dimensions: 6.05 (w) x 8.23 (h) x 0.69 (d)

Meet the Author

Marty Makary, M.D., M.P.H. is a surgeon at Johns Hopkins Hospital and a professor of Health Policy at the Johns Hopkins School of Public Health. He is a regular medical commentator for CNN and FOX News, and appears weekly on a wide variety of programs to discuss health topics. He is a leading patient-safety researcher and led the World Health Organization effort to develop ways to measure healthcare quality. He tweets @DrMartyMD. He lives in the Baltimore/DC area.

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Customer Reviews

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Sort by: Showing all of 8 Customer Reviews
  • Anonymous

    Posted September 20, 2012

    I Also Recommend:

    Dr. Marty Makary, a cancer surgeon at the renowned John's Hopkin

    Dr. Marty Makary, a cancer surgeon at the renowned John's Hopkins School of Medicine, has written a provocative, well-researched, and quite scary book that should be read by physicians, nurses, patients, and hospital administrators. Here are some shocking statistics he gives: One in four hospital patients is hurt by a medical mistake. Thirty to forty percent of our health care dollars pays for fraudulent or unnecessary care. Ten to fifteen percent of patients are not given all their options regarding their care. Possibly the most shocking statistic of all: surgeons operate on the wrong body part 40 times per week!

    To a physician like myself, these statistics are unfortunately not all that surprising. Medicine is administered by humans, and thus subject to human error. Makary writes that the key to improving health care outcomes (and excess cost) is greater transparency. Basically, doctors and hospitals need to be more open with their complication rates, alternative treatments, and be more willing to prevent bad doctors from practicing medicine. Because doctors and hospitals won't make these changes, the key is patient empowerment.

    In that way Makary's book pushes patients to act in their best interests and not accept the status quo. It hearkens back to his contributions with author and medical essayist Atul Gawande in "The Checklist Manifesto: How to Get Things Right." In my hospital, as many others around the country, many of his recommendations are, in fact, being instituted such as with the Keystone initiative. I believe Makary makes some great points which should be seriously considered by hospital administrators and physician leaders.

    While this book is quite scary to the patient, I think it's important to remind readers that the majority of physicians are competent. Some of the stories of terrible doctors can be extremely terrifying to patients, including the cardiac surgeon whose last six patients died during routine heart surgery. He is not the norm.

    If you read this book, I would highly recommend two other books by prominent, caring physicians. They will remind you that the vast majority of doctors practice medicine to help people, not take advantage of the system. The aforementioned Gawande penned the classic "Complications: A Surgeon's Notes on an Imperfect Science," which focuses on medical ethics, unusual patient stories, and the inevitable uncertainty of medicine. It is a very worthwhile read.

    Anthony Youn, MD authored "In Stitches," a sweet, funny, and eye-opening look at the process of becoming a doctor. It's not as alarming as Makary's book, as pensive and serious as Gawande's, but leaves the reader with a sense of hope in the field of medicine. It's a great third book to compliment these two, and will leave you with a smile on your face.

    Even if you read it while occupying a hospital bed.

    8 out of 8 people found this review helpful.

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  • Anonymous

    Posted September 24, 2012

    Dr. Makary has written a very accessible book about the pitfalls

    Dr. Makary has written a very accessible book about the pitfalls of US medicine and how best to avoid the worst of the worst. This book joins a growing list of physician written books that are challenging the "old boy" system of do as I tell you, don't ask questions, don't buck the system. It is only through people become smarter consumers of healthcare, can we change the current system which has the CEO's of pharmaceutical and mega-medical systems, disregarding the loss of health and life as a "cost of doing business." To them the injuries caused by their drugs, medical supplies and aggressive medical treatments are just collateral damage that is to be "managed" by their corporate legal teams. To not be a victim you must understand your adversary. Mega-healthcare corporations are not in business to get you healthy -but to keep you sick and continually take your hard earned money to maintain the CEO's top 2% lifestyle. Remember that.

    3 out of 4 people found this review helpful.

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  • Anonymous

    Posted January 2, 2013

    Eye Opening, Highly Recommend!

    Even as a nurse, I found this book eye opening to what really goes on in the "background" in hospitals and what makes them tick. It offers some practical advice on choosing healthcare providers and hospitals that I found helpful. It's an interesting read.

    1 out of 1 people found this review helpful.

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  • Posted September 25, 2012

    I have heard a good deal about Dr. Makary¿s new book, ¿Unaccount

    I have heard a good deal about Dr. Makary’s new book, “Unaccountable.” After all, who could miss the publicity he’s getting? And, I find what he says on the talk shows to be fascinating. In fact, that’s what made me pick up the book last week. How is it possible that so many people are being harmed, or even killed, by medical mistakes and we have never heard about it?

    I thought that it was RARE for the wrong body part to be operated on, but according to him, it’s happening as many as 40 times a week! Why are we not hearing about this? (Maybe it’s because, as Dr. Makary says, there are gag orders on any settlement deal.) They amputate the wrong arm and you can’t TELL anyone? What is that about?

    I finished the book in one sitting. Didn’t even get up to make dinner. It was too good to put down. Highly recommend to everyone. It’s truly not just for doctors. It’s for patients. And, who of us hasn’t been a patient at one time or another?

    Get the book!

    1 out of 2 people found this review helpful.

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  • Anonymous

    Posted January 12, 2014

    Awesome read

    Book opens scarey but turns very positive and bright

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  • Anonymous

    Posted December 13, 2013

    Highly Recommended

    This is an excellent overview about how hospitals and doctors are making serious mistakes. The author points out that you should be empowered with medical information so that you can be a better advocate in your health care decisions. A must read for anyone that would like to be more informed about what happening in our medical world. I shared this book with many of my friends, it was that good!!

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  • Anonymous

    Posted October 29, 2012

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  • Anonymous

    Posted July 18, 2013

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