It's Time for Transparency

Date: September 1, 2012

Every physician has horror stories about witnessing the inappropriate, excessive, or incompetent treatment of a patient—and about how a professional code of silence ensures that the public won’t learn about the failings of the offending practitioners or institutions.

Marty Makary, a surgical oncologist and gastrointestinal surgeon at Hopkins Hospital, seems to have more of these tales to tell than most—or at least is more willing to do so. As accountability is becoming a new byword in American medicine—particularly with the nation’s new health care act establishing “accountable care organizations”—the timing could not be more propitious for Makary’s new book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (Bloomsbury Press, 2012).

Although the drive for accountability in health care is accelerating, Makary contends that much remains to be fixed. Many information sources on patient safety are hidden in an impenetrable maze of websites, he notes. Medical institutions and practitioners continue to mislead prospective patients with deceptive advertising, acting as salespersons for—or defensively overusing—potentially unnecessary treatments. What’s more, hospitals fail to discipline errant physicians, and they don’t report fully on the outcomes of the care they provide.

“This is my passion,” says Makary, 41, who spent two years of nights and weekends writing Unaccountable. A colleague of Hopkins’ renowned patient safety advocate Peter Pronovost ’91, Makary has been in the vanguard of such initiatives. He was instrumental in developing the World Health Organization’s wide-ranging medical procedure safety checklist. He is also a leader of the movement that aims to improve the overall standard of care while making treatment options and institutional policies more transparent. As part of this effort, he wants to ensure that the public has easy access to every hospital’s outcomes data on various medical procedures.

Appearing frequently on both CNN and the Fox network as a medical expert, Makary knows the value of riveting stories to make a point. He fills his book with them.

For example, during his training in another hospital, he saw a gastroenterologist, unfamiliar with endoscopic removal of a colon polyp, display admirable humility by calling upon a younger colleague to perform a quick and safe polypectomy by using a wire snare passed through the scope. Days later, a respected but clearly self-important colorectal surgeon spurned Makary’s suggestion that he seek the assistance of the wire-snare expert on an identical case. Instead, the surgeon insisted on performing an invasive operation to remove the patient’s colon. His reason? “I just like to take these out with surgery.”

Then there were the “styles” of two surgeons (again, not at Hopkins). One was warm and affable, the other brusque and demeaning. The affable physician charmed patients with his bedside manner, but his surgical technique was abysmal. His patients suffered a disproportionate number of painful, costly complications—a fact well known in the hospital. The residents called him “Dr. Hodad” (for “Hands Of Death And Destruction”). The other surgeon was known as “The Raptor.” He humiliated staff and patients alike. His surgical technique, however, was superb. The residents despised him personally—but he was the one they’d want to operate on them or a family member.

The staff and residents knew that to air their concerns could be professional suicide, so they remained mum about the individuals and incidents for which they coined devastating nicknames.

Divided into three parts, “Some Random Doctor,” “The Wild West,” and “Transparency Time,” Makary’s 17 chapters are a fascinating blend of discomforting facts, common sense proposals, and an impressive call-to-action.

 “To say that we provide amazing technology and have the world’s best research, therefore we are the safest, is something that doctors say is part of the problem in health care,” says Makary, who is also an associate professor of health policy at the Bloomberg School of Public Health. “We need to be open and honest about our mistakes, our shortcomings, where we can do better, our poor-performing areas in the hospital. And if we can’t be honest about our problems, then we really can’t improve on them. 

“By and large in America, when people walk into a hospital, they walk in blind. And we can do better than that.”  Neil A. Grauer