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Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care Hardcover – September 18, 2012

235 customer reviews

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Editorial Reviews


A startling revelation of the dysfunction deeply embedded in the very culture of American medical practice, problems that health care reform scarcely begins to address. (Peter Boyer, senior correspondent for Newsweek)

A searing indictment from the inside, arguing that the modern health-care industry, unlike almost every other, doesn't disclose its performance or pricing practices to the public and keeps under wraps information about mistakes and substandard quality. (Laura Landro, The Wall Street Journal)

Makary's diagnosis is dangerous, damaging secrecy; his therapy is radical transparency…. [Makary's] argument is powerful…. [he] makes a strong case that the system we have is a disaster for patients. (Trine Tsouderos, Chicago Tribune Printers Row)

A very readable, thought-provoking book that will be of interest to health-care consumers, providers, and legislators. The problems pointed out and the solutions suggested deserve to be part of a national discussion. (Richard Maxwell, Porter Adventist Hospital Library, Denver, Library Journal)

Makary's book makes it perfectly clear that data transparency not only allows people to make informed decisions about their health but also nudges hospitals and physicians to be more vigilant and efficient. (Tony Miksanek, Booklist)

You will be a wiser health consumer for reading this book. (Michael E Johns, M.D., Chancellor, Emory University)

This thought-provoking guide from a leader in the field is a must-read for M.D.s, and an eye-opener for the rest of us. (Publishers Weekly)

Unaccountable is a gripping story about what's wrong with the American healthcare system and what we might do to make it better. (Peter Pronovost MD, PhD, Executive Vice-President, Johns Hopkins Hospital)

Every once in a while a book comes along that rocks the foundations of an established order that's seriously in need of being shaken. The modern American hospital is that establishment and Unaccountable is that book. (Shannon Brownlee, author of Overtreated)

A galvanizing book full of shocking truths about the current state of health care. (Kirkus Reviews)

About the Author

Marty Makary, M.D., M.P.H. is a surgeon at Johns Hopkins Hospital and a professor of Health Policy at the Johns Hopkins School of Public Health. He is a regular medical commentator for CNN and FOX News, and appears weekly on a wide variety of programs to discuss health topics. He is a leading patient-safety researcher and led the World Health Organization effort to develop ways to measure healthcare quality. He tweets @DrMartyMD.


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Product Details

  • Hardcover: 256 pages
  • Publisher: Bloomsbury Press; 1 edition (September 18, 2012)
  • Language: English
  • ISBN-10: 1608198367
  • ISBN-13: 978-1608198368
  • Product Dimensions: 6.4 x 0.9 x 9.6 inches
  • Shipping Weight: 11.8 ounces (View shipping rates and policies)
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (235 customer reviews)
  • Amazon Best Sellers Rank: #471,072 in Books (See Top 100 in Books)

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More About the Author

Marty Makary is the author of "Unaccountable," a story about modern medicine's transparency revolution.

Dr. Makary is a practicing surgeon at Johns Hopkins Hospital and an associate professor of health policy at the Johns Hopkins School of Public Health. A medical commentator for a CNN and FOXNews, he speaks regularly on the sociology of medicine and the future of healthcare. Dr. Makary led the effort of the World Health Organization (WHO) to measure hospital complications and was the first to publish studies on the use of a checklist in surgery. He later worked closely with Dr. Atul Gawande to develop the official WHO checklist. Dr. Gawande credits the co-development of the surgical checklist to Dr. Makary in his best-selling book, "The Checklist Manifesto".

Dr. Makary's research has appeared in the New England Journal of Medicine and numerous other medical journals. He is the recipient of research grants from the Department of Health and Human Services Agency for Healthcare Research and Quality and has written extensively on the subject of patient empowerment in healthcare. He serves in leadership roles at the American College of Surgeons and is the author of "General Surgery Review," a standard textbook used in many medical schools. In 2007, Dr. Makary was named the Mark Ravitch Chair of Gastrointestinal Surgery at Johns Hopkins. His current role is Director of Surgery Quality and Safety at Johns Hopkins. He specializes in cancer surgery and is the Director of the Johns Hopkins Pancreas Islet Transplant Center.

Dr. Makary holds degrees from Bucknell University, Thomas Jefferson University, and Harvard University. He completed his surgical training at Georgetown University and subspecialty training at Johns Hopkins University. He lives in the Washington D.C. area.

Customer Reviews

Most Helpful Customer Reviews

99 of 103 people found the following review helpful By Jack on September 18, 2012
Format: Hardcover
Dr. Marty Makary, a cancer surgeon at the renowned John's Hopkins School of Medicine, has written a provocative, well-researched, and quite scary book that should be read by physicians, nurses, patients, and hospital administrators. Here are some shocking statistics he gives: One in four hospital patients is hurt by a medical mistake. Thirty to forty percent of our health care dollars pays for fraudulent or unnecessary care. Ten to fifteen percent of patients are not given all their options regarding their care. Possibly the most shocking statistic of all: surgeons operate on the wrong body part 40 times per week!

To a physician like myself, these statistics are unfortunately not all that surprising. Medicine is administered by humans, and thus subject to human error. Makary writes that the key to improving health care outcomes (and excess cost) is greater transparency. Basically, doctors and hospitals need to be more open with their complication rates, alternative treatments, and be more willing to prevent bad doctors from practicing medicine. Because doctors and hospitals won't make these changes, the key is patient empowerment.

In that way Makary's book pushes patients to act in their best interests and not accept the status quo. It hearkens back to his contributions with author and medical essayist Atul Gawande in The Checklist Manifesto: How to Get Things Right. In my hospital, as many others around the country, many of his recommendations are, in fact, being instituted such as with the Keystone initiative. I believe Makary makes some great points which should be seriously considered by hospital administrators and physician leaders.
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29 of 30 people found the following review helpful By R. Scott Lorenz on October 11, 2012
Format: Kindle Edition Verified Purchase
In 'Unaccountable' Dr. Makary discusses how common sense solutions can fix the healthcare system by empowering patients with information to choose where to go for their medical care. The problem is that the health care industry hides and protects bad doctors, bad practices and bad outcomes.

If the public only knew what really goes on, you would be shocked. In my line of work, I am privy to settlements between hospitals and patients who have been harmed. One common element in all these settlements is confidentiality. Nobody can say anything about the lawsuit, the amount of the settlement or anything. How does the withholding of that information help the public? It doesn't.

The transparency that Dr. Makary talks about is what is needed. But changing the way medicine is done in the USA won't happen overnight. I highly recommend that everyone read 'Unaccountable' and if you find this of interest another book along the same lines called 'Getting Over Going Under: 5 Things you Must Know before Anesthesia' by Dr. Barry Friedberg which covers his 20+ year struggle to change just one item in health care, i.e. getting hospitals to use a brain monitor during surgery.

Hats off to both doctors for shedding light on the health care industry's culturally ingrained obfuscation of the truth and resistance to change.
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49 of 56 people found the following review helpful By Mary Terpak on September 18, 2012
Format: Hardcover Verified Purchase
My question, after reading "Unaccountable," wasn't why Dr. Makary had written such a book, but why another doctor hadn't written this book sooner?

"Unaccountable" is a raw and stark look inside the American medical system. Sucking you in, right from the start, with the true story of HODAD - a renowned surgeon at Harvard - worshiped by his patients, but known to all the residents to be the most dangerous doctor on staff - Dr Makary paints a picture of a medical system that is viewed to be a well-oiled machine, but in actuality, is more like "The Wild West," rampant in medical mistakes and impaired physicians.

Dr. Makary argues that transparency is the key to revolutionizing health care in the U.S., and is, instead, convinced doctors and hospital administrators need to stop their ever-present culture of secrecy. Patients should not walk blindly into hospitals, but have full access to a wealth of data regarding infection rates and surgical complications. According to Dr. Makary, hospitals have little to no incentive to improve these "danger zones," to the detriment of their patients, and only once they are forced to be competitive in their level of patient safety will Americans receive the care they deserve.

Though, a bit disappointed that Dr. Makary did not delve a bit more into the unethical mistakes of the pharmaceutical industry, (perhaps he will take on this issue in his next book) he does horrifyingly discuss how cancer doctors actually make a good deal more money if a patient is prescribed chemo than if he is given an alternative option.

"Unaccountable" is not just for doctors, though, it is imperative they devour every word. Above all, it is a necessary read for everyone who has ever known someone in a hospital, has ever been in a hospital or might someday find themselves a patient in a hospital. I'm fairly certain that doesn't leave anyone out!
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27 of 33 people found the following review helpful By Geraldine Ahearn TOP 500 REVIEWERVINE VOICE on September 19, 2012
Format: Hardcover
As a healthcare provider for thirty years and working in different hospitals as a CCRN, several specialty areas of the hospital, and a pharmacy within the hospital setting, I totally agree with Dr. Marty Makary and wish this book was published a long time ago. However, the facts and presentation he delivers in reference to Doctors and Hospitals being unaccountable, increasing error rates and cost rates, and how to repair a broken healthcare system is valuable information needed to bring to the attention of the general public Now! This powerful, informative, and concise story reveals the shocking truths in a dysfunctional American Medical Practice. This thought-provoking story is essential for exposure of the dangers encountered, so that positive change can reform and repair a broken system. As important as it is to reward Good Performance, it's even More important to frequently check for systemic flaws to ensure that the same mistakes are not repeated. In addition, as the author conveyed the importance of patients being educated through patient-teaching is a crucial factor noted that every patient needs to know what the healthcare workers know. There must be room for improvement, so that the problems could be fixed with mandatory solutions. Frequent checklists need to circulate on every hospital unit and evaluated on a timely basis. This gripping story is a wake-up call for America's current Healthcare system, which is in dire need for repair. I highly recommend this important book to all healthcare workers, and patients. Educational, well-written, and easy to read!
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