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Hopkins Surgeon Blasts Healthcare Safety, Ethics

Cheryl Clark, for HealthLeaders Media, September 13, 2012

"I observed the surgical community demarcate," he says. "The small group of skilled doctors did this (new lap) procedure for all patients," while others did it through an open operation. But there was almost no dialogue about steering patients toward this superior approach.

"Instead, what I noticed was that (these less-skilled) surgeons would not talk about what was in the medical literature. Instead, they would sometimes mock (the lap procedure), and refer to it a 'not as much fun' as the open operation.

"I saw a competitive environment where surgeons were under pressure to generate more revenue and walk home at the end of the year with $1,000 to $2,000 more for each procedure that they did not refer to someone else. Huge financial incentives that lure doctors to offer suboptimal care. And that was just my own little space."

In talking with colleagues, he realized this practice goes on "in almost every specialty." Some do it just for the money, he says, but others do it because of medicine's "grey zone, those situations where it's a borderline call on whether the patient really needs to have something done."

These are "giant financial pushes" that Makary also calls "kickbacks that are not disclosed to patients in the United States from industry and drug device companies" because no one is accountable to anyone.

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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 This points out the dangerous hierarchy that exists in health care; an outdated model that looks more like 19th century obedience to a master than 21st century collaboration among equals.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.