Tuesday, September 11, 2012

Marty Makary suggests transparency

I haven't read the book yet, but this review of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care by Dr. Marty Makary makes it look like something worth reading.

Here's are some excerpts from the review:

Though concepts such as “accountability” and “transparency” have been trotted out from time to time, Makary believes that medicine is still a closed shop. In Unaccountable, he specifically targets hospitals, arguing that they need to gather, analyze, and publish information vital to prospective patients. They should keep precise tabs on patients’ surgical outcomes, the rate of hospital-borne infections, and other measures, and then put the statistics out where the public can see them (including on the Internet). Doing that would encourage hospitals to hold themselves to higher standards. They would be forced to rehabilitate, train, or weed out physicians and other professionals who need to do better, Makary says, and the practice of medicine would be greatly improved. By focusing only on best practices, hospitals would also reduce the cost of care. 

Meanwhile, hospitals see little gain in presenting statistics about their performance, Makary says—another impediment to better treatment. “Their thinking is, ‘What if we have a bad year?’ They’d rather keep the steady stream of money coming in. They know that people view them as a beneficent entity, almost a charity.

While many hospitals highlight glitzy new cancer centers, Makary believes they should emphasize safety at least as assiduously. “Advances in patient safety will save more lives than chemotherapy this year,” he says.

For all the brewing hubbub, Makary insists he’s not so much a single-minded activist as a messenger. “I didn’t create this movement,” he says. “We’re at a turning point in American medicine now. There is a new generation of physicians that believes medicine should be transparent, that is tired of the old b.s., and wants to change things.” But the old guard isn’t far behind—which gives Makary even more hope. The Institute of Medicine, a vaunted research entity that often investigates best practices, and the American Board of Internal Medicine are starting to take accountability seriously. Even the doctor-protective American Medical Association has taken notice. “Doctors are monitoring exactly what they do. They’re researching and questioning it,” he says. “It’s unprecedented.” 


Anonymous said...

The review is excellent, and worth clicking on the link.
One addiitonal quote caught my eye by one of my former professors at UVa:
"{Michael} Johns, who got a sneak peek of the book, pre-publication, offers one caution: “He does a really nice job of grabbing readers’ attention with his stories. But the book needs to be read in the right sense, and that is that there’s room for improvement. You don’t want people to read it and be afraid of seeking out care.”

Au contraire, I think people DO need to be afraid of seeking out care for anything to change. Think of all the verbiage and print to this day, and not much is different.

nonlocal MD

narkose said...

'Getting Over Going Under' deals with the most frightening place in the hospital, the operating room & the anesthesia given there.

Brain monitors are found in 75% of US hospitals , yet only used 25% of the time.

Without a brain monitor, you are 99% guaranteed to be over medicated to avoid anesthesia awareness.

Anesthesia over medication is especially dangerous for aging baby boomers & their parents.

Do not play Russian roulette with your mind by having anesthesia without a brain monitor.

The public education message of the non-profit Goldilocks Anesthesia Foundation is simple & clear:

No surgery under anesthesia without a brain monitor.