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Hopkins Surgeon Blasts Healthcare Safety, Ethics

Cheryl Clark, for HealthLeaders Media, September 13, 2012

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.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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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.