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26 reviews for:
Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
Marty Makary
4.15 AVERAGE
26 reviews for:
Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
Marty Makary
4.15 AVERAGE
informative
medium-paced
interesting, thought provoking, public health economics
This book does a great job of describing the dysfunctional reality of hospital health care -- and also working as a bit of consumer's guide. Recommended for anyone dealing with a complex health condition or surgery.
The author did a very long, very interesting interview on the Peter Attia podcast that I also recommend: https://peterattiamd.com/martymakary/
The author did a very long, very interesting interview on the Peter Attia podcast that I also recommend: https://peterattiamd.com/martymakary/
Wow.
Selected quotes:
"...frustrated by two trends in modern medicine: 1) hospital administration being increasingly removed from daily hospital care, and 2) modern medicine's growing appetite to over-screen, over-diagnose, and over-treat."
"...the reason there was no business case for his plan to lower complications was that hospitals profit from bad medical care. He realized that hospitals get more money for each complication, X-ray, and extra patient day in the ICU. One well-known national study...estimated that a hospital gets paid $10,000 extra per surgical complication."
"The result of the release of this data (heart surgery death rates in New York)? Big, broad improvements in mortality, statewide. With each passing year of public reporting, the state's average death rate went down."
"Despite hospitals howling in protest when Chassin's program (heart surgery death rate reporting) was announced, future patients benefited from the transparency. Statewide, deaths from heart surgery fell by 41 percent during the first four years...and have continued to decrease ever since."
"...found that surgical death rates are directly related to a surgeon's experience with that particular operation....low-volume heart surgeons recorded a mortality rate four times higher than the state average."
"Volume also matters in all medical care, not just procedures. When seeking care for a possible stroke, persistent cough, or possible tick bite, you should be able...to see how many case [of each] each medical center in your area treats each year."
"...I've been amazed that each doctor has their own personal threshold to give a blood transfusion to patients with anemia, or low blood level, despite established guidelines."
"When choosing a hospital, beware of clever marketing....Insist on finding out how many patients they treat each year for your condition...Patient satisfaction surveys do not capture quality medical care, and 'top' scores and rankings in magazines are often paid for."
"...I, like all surgeons, am also statistically more likely to be overconfident about my skills than underconfident. This is part of our DNA as surgeons."
"Many surgeons I know don't offer patients minimally invasive or cutting-edge options only because they don't know how to do them. Further, the pattern of which doctors offer it and which doctors don't has no correlation with the prestige or the size of the hospital..."
"All surgery has risks, so your goal should be to err on the side of less is more, unless the need fro the more invasive procedure is very clear. Many procedures in medicine now have a minimally invasive equivalent."
"A hysterectomy is the second most common operation performed in the United States, behind only its cousin operation, the C-section. Roughly one-third of women will have a hysterectomy by the age of sixty. Yet half of women who get the procedure will have the bigger open operation rather than the minimally invasive version."
"Medical care varies widely within our country's best hospitals. And modern medicine is not the standardized discipline most people think it is."
"When further testing is recommended, be sure to ask what the incremental benefit is, since it can sometimes be avoided. Doctors generally assume insurance is footing the bill, so we have a tendency to order tests liberally."
"You want the person with the most experience in treating your specific condition."
"More relevant than any other screening tool is the question: 'How many cases of this type does this doctor see each year?'"
"Hospitals are paid more for operations that result in multiple complications than for operations that have none. So they have no financial incentive to invest in prevention or to monitor anything that might reflect poorly upon them, might get them bad press, or that requires them to do a lot of extra work."
"Finally. A way to accurately measure patient outcomes had arrived! (Referring to the National Surgical Quality Improvement Program) But not for the public. The data is locked and sealed tighter than Fort Knox. Hospitals don't want you to see it. In hospital speak, we call it 'sensitive data,' available only with the hospital names removed."
"In fact, rates of serious substance abuse and psychiatric disease among doctors are actually higher than that of other professions with similar educational background and socioeconomic status."
"Even doctors in rehab who test positive for illegal drugs or are arrested can keep their licenses and continue to diagnose, prescribe, and operate as before. Unbeknownst to the public, surgeons can be arrested for driving drunk or stoned and then go into surgery the next day."
"Admirably, some hospitals have started taking the bold step of having their 'mishaps' reviewed by doctors at another hospital - one that has no business or political conflicts of interest. This new 'external review,' easily done via teleconferencing, eliminates the many barriers to honest feedback..."
"A New England Journal of Medicine study concluded that as many as 25 percent of all hospitalized patients will experience a preventable medical error or some kind."
"...her surgery took place in a freestanding surgery center where there was no adjacent hospital to handle emergencies...if something goes wrong, they are going to be up a proverbial creek without a paddle."
"Yes, doctors make a commission on the sales price of the chemo. Unlike other medications that can be bought on the free market with a prescription, most chemo medications are sold only at hospitals. If you choose chemo, the doctor and hospital make thousands more in income in the form of a markup on the drug. People need to know about hospital's financial incentive to give chemotherapy."
"Whenever confronted with a decision about your medical care, inquire about the difference in average outcomes and quality of life among the options..."
"Wouldn't you want to know if your hospital e-mails its doctors threatening not to pay them their bonuses if they do not reach procedure volume targets?"
"Of the roughly two hundred thousand heart angioplasty procedures done in the United States each year for patients without heart-attack symptoms, 38 percent are done for uncertain indications and 12 percent are done for 'inappropriate' indications, according to a study published in 2011 in the prestigious Journal of the American Medical Association..."
"When I get a few beers into my colleagues who promote robotic surgery, they too will often admit that it's mainly a marketing hook to attract patients."
"...patient-advocacy groups recommend that patients bring a friend or family member with them for important doctor visits so there is a second set of ears to listen while the patient is absorbing what could be a life-changing diagnosis."
"As many as half of all medical records have been shown to contain mistakes in medication lists and other key elements of background information."
"...a research study came out showing an 83 percent increase in complications after elective surgery when the surgeon was on call the night before and hadn't gotten adequate sleep."
"Blanket recommendations should be avoided, such as medication for everyone with a slightly high blood pressure or a high LDL cholesterol. If you made it to old age without medication...you probably don't need to start now..."
"Hospitals are not required to report their complication rates, readmission rates, or other standardized metrics of how they are performing. The only minor exception is a brand-new Medicare requirement for hospitals to begin reporting infection rates following a small subset of procedures."
"A consumer should be able to look up the percentage of hospitalized patients who are readmitted to a hospital within ninety days, categorized by the discharging diagnosis."
"Ask any businessperson why health care is hemorrhaging cash and you'll be told that there's no measurable product. Money is poured into the system with no record of how it's performing."
CitizensForPatientSafety.Org
Selected quotes:
"...frustrated by two trends in modern medicine: 1) hospital administration being increasingly removed from daily hospital care, and 2) modern medicine's growing appetite to over-screen, over-diagnose, and over-treat."
"...the reason there was no business case for his plan to lower complications was that hospitals profit from bad medical care. He realized that hospitals get more money for each complication, X-ray, and extra patient day in the ICU. One well-known national study...estimated that a hospital gets paid $10,000 extra per surgical complication."
"The result of the release of this data (heart surgery death rates in New York)? Big, broad improvements in mortality, statewide. With each passing year of public reporting, the state's average death rate went down."
"Despite hospitals howling in protest when Chassin's program (heart surgery death rate reporting) was announced, future patients benefited from the transparency. Statewide, deaths from heart surgery fell by 41 percent during the first four years...and have continued to decrease ever since."
"...found that surgical death rates are directly related to a surgeon's experience with that particular operation....low-volume heart surgeons recorded a mortality rate four times higher than the state average."
"Volume also matters in all medical care, not just procedures. When seeking care for a possible stroke, persistent cough, or possible tick bite, you should be able...to see how many case [of each] each medical center in your area treats each year."
"...I've been amazed that each doctor has their own personal threshold to give a blood transfusion to patients with anemia, or low blood level, despite established guidelines."
"When choosing a hospital, beware of clever marketing....Insist on finding out how many patients they treat each year for your condition...Patient satisfaction surveys do not capture quality medical care, and 'top' scores and rankings in magazines are often paid for."
"...I, like all surgeons, am also statistically more likely to be overconfident about my skills than underconfident. This is part of our DNA as surgeons."
"Many surgeons I know don't offer patients minimally invasive or cutting-edge options only because they don't know how to do them. Further, the pattern of which doctors offer it and which doctors don't has no correlation with the prestige or the size of the hospital..."
"All surgery has risks, so your goal should be to err on the side of less is more, unless the need fro the more invasive procedure is very clear. Many procedures in medicine now have a minimally invasive equivalent."
"A hysterectomy is the second most common operation performed in the United States, behind only its cousin operation, the C-section. Roughly one-third of women will have a hysterectomy by the age of sixty. Yet half of women who get the procedure will have the bigger open operation rather than the minimally invasive version."
"Medical care varies widely within our country's best hospitals. And modern medicine is not the standardized discipline most people think it is."
"When further testing is recommended, be sure to ask what the incremental benefit is, since it can sometimes be avoided. Doctors generally assume insurance is footing the bill, so we have a tendency to order tests liberally."
"You want the person with the most experience in treating your specific condition."
"More relevant than any other screening tool is the question: 'How many cases of this type does this doctor see each year?'"
"Hospitals are paid more for operations that result in multiple complications than for operations that have none. So they have no financial incentive to invest in prevention or to monitor anything that might reflect poorly upon them, might get them bad press, or that requires them to do a lot of extra work."
"Finally. A way to accurately measure patient outcomes had arrived! (Referring to the National Surgical Quality Improvement Program) But not for the public. The data is locked and sealed tighter than Fort Knox. Hospitals don't want you to see it. In hospital speak, we call it 'sensitive data,' available only with the hospital names removed."
"In fact, rates of serious substance abuse and psychiatric disease among doctors are actually higher than that of other professions with similar educational background and socioeconomic status."
"Even doctors in rehab who test positive for illegal drugs or are arrested can keep their licenses and continue to diagnose, prescribe, and operate as before. Unbeknownst to the public, surgeons can be arrested for driving drunk or stoned and then go into surgery the next day."
"Admirably, some hospitals have started taking the bold step of having their 'mishaps' reviewed by doctors at another hospital - one that has no business or political conflicts of interest. This new 'external review,' easily done via teleconferencing, eliminates the many barriers to honest feedback..."
"A New England Journal of Medicine study concluded that as many as 25 percent of all hospitalized patients will experience a preventable medical error or some kind."
"...her surgery took place in a freestanding surgery center where there was no adjacent hospital to handle emergencies...if something goes wrong, they are going to be up a proverbial creek without a paddle."
"Yes, doctors make a commission on the sales price of the chemo. Unlike other medications that can be bought on the free market with a prescription, most chemo medications are sold only at hospitals. If you choose chemo, the doctor and hospital make thousands more in income in the form of a markup on the drug. People need to know about hospital's financial incentive to give chemotherapy."
"Whenever confronted with a decision about your medical care, inquire about the difference in average outcomes and quality of life among the options..."
"Wouldn't you want to know if your hospital e-mails its doctors threatening not to pay them their bonuses if they do not reach procedure volume targets?"
"Of the roughly two hundred thousand heart angioplasty procedures done in the United States each year for patients without heart-attack symptoms, 38 percent are done for uncertain indications and 12 percent are done for 'inappropriate' indications, according to a study published in 2011 in the prestigious Journal of the American Medical Association..."
"When I get a few beers into my colleagues who promote robotic surgery, they too will often admit that it's mainly a marketing hook to attract patients."
"...patient-advocacy groups recommend that patients bring a friend or family member with them for important doctor visits so there is a second set of ears to listen while the patient is absorbing what could be a life-changing diagnosis."
"As many as half of all medical records have been shown to contain mistakes in medication lists and other key elements of background information."
"...a research study came out showing an 83 percent increase in complications after elective surgery when the surgeon was on call the night before and hadn't gotten adequate sleep."
"Blanket recommendations should be avoided, such as medication for everyone with a slightly high blood pressure or a high LDL cholesterol. If you made it to old age without medication...you probably don't need to start now..."
"Hospitals are not required to report their complication rates, readmission rates, or other standardized metrics of how they are performing. The only minor exception is a brand-new Medicare requirement for hospitals to begin reporting infection rates following a small subset of procedures."
"A consumer should be able to look up the percentage of hospitalized patients who are readmitted to a hospital within ninety days, categorized by the discharging diagnosis."
"Ask any businessperson why health care is hemorrhaging cash and you'll be told that there's no measurable product. Money is poured into the system with no record of how it's performing."
CitizensForPatientSafety.Org
informative
inspiring
medium-paced
As one might expect from a book of similar length and title, the book relies too heavily on shocking statistics and stories to make a point than it should. However, assuming that everything presented in the book is true, we should probably all be a bit shocked and terrified. From surgeons who pretend to be more experienced than they are in order to do more surgeries and therefore make more money to the health care system's inability to prevent doctors who are addicted to drugs and alcohol from practicing medicine to the extreme mistrust between medical staff that undermines proper care at many medical facilities, there are definitely some scary things going on in the medical system.
Overall, I felt that book could have been better researched(much of the evidence presented was anecdotal or from studies that the author himself had written or co-written), and more solutions to the problems presented could have been suggested. That said, it was quite eye-opening.
Overall, I felt that book could have been better researched(much of the evidence presented was anecdotal or from studies that the author himself had written or co-written), and more solutions to the problems presented could have been suggested. That said, it was quite eye-opening.