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99 of 103 people found the following review helpful
on September 18, 2012
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.

While this book is quite scary to the patient, I think it's important to remind readers that the majority of physicians are competent. Some of the stories of terrible doctors can be extremely terrifying to patients, including the cardiac surgeon whose last six patients died during routine heart surgery. He is not the norm.

If you read this book, I would highly recommend two other books by prominent, caring physicians. They will remind you that the vast majority of doctors practice medicine to help people, not take advantage of the system. The aforementioned Gawande penned the classic Complications: A Surgeon's Notes on an Imperfect Science, which focuses on medical ethics, unusual patient stories, and the inevitable uncertainty of medicine. It is a very worthwhile read.

Anthony Youn, MD authored In Stitches, a sweet, funny, and eye-opening look at the process of becoming a doctor. It's not as alarming as Makary's book, as pensive and serious as Gawande's, but leaves the reader with a sense of hope in the field of medicine. It's a great third book to compliment these two, and will leave you with a smile on your face.

Even if you read it while occupying a hospital bed.
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29 of 30 people found the following review helpful
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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46 of 53 people found the following review helpful
on September 18, 2012
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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26 of 32 people found the following review helpful
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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18 of 22 people found the following review helpful
on September 20, 2012
I have read all the other reviews and I agree with everything they say.

Unaccountable does an incredible job delving into the disturbing world of medicine and unaccountability in our healthcare system. And, don't get me wrong, I, too, was fascinated by the stories of medical mistakes and how those who experience them are `gagged' - meaning, they sign an agreement that, in order to receive their settlement, they will never speak of what happened to them (thus protecting the skin of those negligent and eliminating any chance for change).

But, those terrible stories are not the most important thing I took away from this book - and I think if you walk away from this book filled with fear (or perhaps, stay away from it because of it), you are missing the whole point!

Unaccountable is a book of hope! It has invaluable tools inside that can empower the patient and their families in times of crises when it seems like there are no answers. Having lived through a few horrible medical experiences with ones I've loved, the moment your family member or friend is brought into the ER is NOT the time to begin wondering what to say and ask and "where do we go from here?"
We need to have this information in advance and Unaccountable is like a God-given handbook on how to navigate an incredibly confusing and non-patient-friendly system.

The first thing we each need to do? Take Dr. Makary's list (on page 64) of questions you should ask before any procedure - and then we need to type it up on a little card, laminate it, stick it in our wallet and give a copy to everyone we love for Christmas! You never know when you will need that list! Will you have the book with you when you do? No! The moment a doctor tells you your loved one is about to have life-or-death surgery is not the time to go searching for it.
There is hope for our broken system and for the first time in, forever, I see it! It has nothing to do with what any politician has to say about how to fund our billion-dollar healthcare system. It has to do with how to FIX the system so that it doesn't cost us a billion dollars in lawsuits and over-medicating our patients and cover-ups and CEO outrageous salaries.

I can't say enough good things about Unaccountable. You have to read it. You have to give it your Grandma to read. Your doctor. The guy at the grocery store you chat with when you buy your produce. Yes, it's that good.
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14 of 17 people found the following review helpful
on September 27, 2012
I am a critical care nurse with over 30 years in the trenches and when I heard
Dr. Marty Makary on a radio interview I very much wanted to read his book "Unaccountable: What Hospitals won't tell you...". From the very first page it brought back many bad memories of MD's I have encountered over the course of my career starting with Dr. HODAD (only in my hospital he was known as Dr. STAPH)and continued as he spoke about patient's persuaded against their own wishes and better judgement to undergo procedures that certainly did not enhance their quantity or quality of life. However, it is not only MD's who do not police their own collegues it is also nursing administration who protect incompetent, dangerous, and often impaired nurses, aides and MD's by inaction until a sentinel event occurs. I have shed many tears over the stories and information book and truly believe that it should be REQUIRED reading at every Medical, Nursing School and where the public can find a copy.
Pat CCRN
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37 of 49 people found the following review helpful
This is a timely book that could not have been written by anyone better than Dr. Makari who is recognized for his pioneering work in patient safety nationally as well as internationally through his leadership at the World Health Organization.
The book has unwittingly shown what most of us suspected for years, that the "meccas" of medicine are too busy churning out studies and publishing papers while overlooking basic safety precautions. Most of the "improvements" advocated in the book were already being implemented in many community hospitals for the last 20+ years. The author's litany of anecdotes about bad doctors with cutesy monikers of "Hodad", Shrek etc. may resonate in mainly teaching hospitals but is a thing of the past in modern community medical centers. The latter are in constant competition to attract patients and as such cannot abide too many negative outcomes. Word of mouth is enough to damage the reputation of a physician or hospital with too many bad results, which ultimately has a negative impact on the bottom line. Publishing hospital results is beneficial, as long as the numbers are not fudged or padded (as what happened recently with the education system). As a surgeon of over 35 years experience, both in Academics and private practice, and in leadership positions at teaching institutions and community hospitals I have developed a realistic insider's perspective of the profession, aware of its shortcomings and not an apologist for its failings.

The "white coat code of silence" has been in existence since medicine became a profession and has even tightened up ever since the onslaught of so-called malpractice suits began in the 1970s until now. But this has also greatly increased the internal policing and self-scrutiny of hospitals and their medical staffs to protect against liability. Incompetent, impaired or negligent physicians are brought to task, their privileges are curtailed or suspended and recidivists are often expelled from the staff. This is usually done "in camera" without fanfare and almost never publicly. Physicians in community hospitals are mostly in private practice and are immune to the vagaries of promotions or demotions, salary increases or being fired by the Chairman if they criticized a colleague; as opposed to their counterparts employed by Universities etc.. The fiction that physicians "look the other way" about a wayward colleague and do nothing is from the remote past. Most modern hospitals have Quality Assurance Teams that survey and report about complications on a bi-weekly basis. Any deviation from established benchmarks are flagged and immediately corrected. Chronic outliers are censored by disciplinary committees of their peers.

I presume that this review shall be in the minority, as lately it has become fashionable to pile on the medical profession and its institutions.
I found the book to be uneven and alarmist. It appeared to be written for the general public but also goes into minutiae more suited for the professional. The multiple examples of unnecessary cardiac, spine and orthopedic procedures for financial gain was overkill. These are outliers and not the norm. The majority of physicians are honest and decent altruistic individuals. Unfortunately, as in every profession there are bad apples that stand out and tarnish the profession.
As for the surgical check list, many community hospitals have been doing it for decades to mitigate liability. Only lately several authors from the ivory towers of Harvard, Johns Hopkins et al. have been preaching the gospel of checklists.
The author, along with his colleague Dr. Pronovost at the Armstrong Safety Institute, are to be commended for their work in creating a checklist system to prevent medical errors. One surgical mishap is one too many, 100,000 is a disaster.
The astute readers should be able to parse the information about hospitals in general and their own community medical center in particular. They should gather pertinent information within their community and avoid being unnecessarily fearful of their hospital.
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15 of 19 people found the following review helpful
on October 4, 2012
October 3, 2012 By Steven E. Greer, MD The Healthcare Channel

Johns Hopkins general surgeon Marty Makary, MD, MPH, takes on the corporatization of the $2.7 Trillion dollar American healthcare system in his book "Unaccountable". He boldly exposes through anecdotes how unsafe it can be to visit a hospital, and how some incompetent surgeons can go unchecked throughout their careers by a broken network of state bureaucrats in charge of policing bad doctors. He describes in the book numerous different problems that persist in American healthcare enabled by a complete lack of accountability that would never be tolerated by CEO's of other industries. This is an important book by Dr. Makary given that so few have been willing to speak out heretofore.

Dr. Makary begins with a chapter describing what every doctor has experienced, which is a horribly incompetent surgeon who manages to succeed nevertheless through the use of good bedside manner and other social skills. As a surgeon in training, one of his professors was nicknamed "Dr. Hodad", which was a secret acronym for "Hands of Destruction and Death". The book then describes the pervasive culture shared by most divisional Chiefs and Chairs to prioritize protecting the medical profession over protecting the patient, and how any doctor reporting another doctor's unsafe ways would be ostracized, demoted, or even fired.

The anecdotes in the book are quite funny for the surgeon reader, and likely very shocking to the lay reader. Dr. Makary's insider view of the profession is refreshing given that almost all pop culture portrayals of medicine and surgery are ones of flawless gods saving lives and having sexy affairs with one another.

Dr. Makary is uniquely qualified to write about problems in the American system leading to unnecessary patient harm given his extensive background of clinical research on patient safety. He took time off during medical school to matriculate throughout the Harvard MPH program. Later, he led the World Health Organization (WHO) in creating a surgical checklist system to prevent operating room errors, which was then popularized by Harvard's surgery guru Atul Gawande. Of note, the person most responsible for the medical checklist concept is Dr. Peter Pronovost, a colleague of Dr. Makary's at Johns Hopkins who runs the Armstrong Safety Institute.

In some chapters of "Unaccountable", specific financially motivated unnecessary treatments are detailed. For example, the rise of "Comprehensive Cancer Centers" popping up everywhere, that are far from "comprehensive", is explained. Cancer is a very profitable business for a struggling community hospital because chemotherapy drugs are legally allowed to be sold at a large markup. In addition, other therapies that pay well, such as radiation therapy for tumors, have little evidence to support the widespread use. In cardiology, coronary stent overusage is discussed. In orthopedic surgery and neurosurgery, the scam detailed is unnecessary, yet lucrative, spine surgery to treat back pain, when physical therapy is an equally effective alternative.

Dr. Makary then summarizes some model examples of medical systems that have made public safety data that then led to improvements in those parameters. He writes about "The New York Experiment" and how the state health commissioner, Mark Chaissin, created a registry of cardiology procedures and safety outcomes to address the growing problem of unsafe cardiac surgery programs. Once the problematic outlier programs were identified, corrective measures were taken. However, in almost all other states, these sensitive data are not collected in proper registries and are not made public.

The weaknesses of the book "Unaccountable" are in the inconsistent target audiences of each chapter and lack of detail in others. Dr. Makary seems to oscillate from trying to reach a lay-person patient audience, to trying to reach an MD or MPH audience. In Chapter 7 "Tap the Power of Patient outcomes", for example, some rather "wonky" MPH studies are presented with graphs showing how collecting surgical outcome data can help to identify problems to be addressed. Then, in Chapter 8 "Impaired Physicians", the book completely changes back to the style of anecdotes meant to enlighten patients, but which are well known to most doctors.

"Unaccountable" would have been a far stronger work had it settled on a consistent target audience. To educate patients enough to allow them to take control of their medical care and prevent costly and harmful unnecessary tests or procedures, there could have been chapters with lists "naming names". Specific drugs that are massively overprescribed, such as statins in primary prevention, or aspirin in primary prevention, could have been listed. A chapter giving patients their own "checklist" on what to ask of their hospital upon being admitted would have been helpful as well. (Of note, a book of this nature has been in production by the author of this book review, Dr. Greer).

Dr. Makary concludes in Chapter 17 "What Accountability Looks Like" with lists of what he deems to be tested and verified systems for reducing hospital errors. He writes that if hospitals were to make public the parameters such as readmission rates within 30-days, surgical complication rates, or infection rates, that then the accountability created would lead to overall reductions in these adverse events. That might be true to a certain extent, but not mentioned by Dr. Makary is how strict outcomes measures like those, which are tied to job promotions and salary, are often gamed and manipulated. Just as the New York Police Department is under investigation for underreporting crime rates because precinct commanders' jobs are at stake, so too will infection rates be under-reported. If Medicare or Medicaid reimbursement to medical centers is made contingent upon hospital safety outcome measures, then as sure as the sun rises, those data will be manipulated.
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5 of 5 people found the following review helpful
on January 28, 2013
It's the book I always thought i should write myself!
It's all there, everything you need to consider when being a good doctor!
This is what you need to know as a patient in to days advanced healthcare system.
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10 of 13 people found the following review helpful
on September 26, 2012
I happen to know Marty Makary because he removed a tumor from my pancreas 4 1/2 years ago at Johns Hopkins. At the time, I could tell he had world-class integrity, was as intelligent as any physician could be, but more importantly had the biggest heart. (He volunteers for WHO (World Health Organization), traveling around the world, and was on a committee to help not-yet-President Obama understand about health care in the U.S.) So when I picked up this month's Reader's Digest and the first, excellent quote in the article "What Your Surgeons Don't Want You to Know" was by Dr. Makary and it said he had a new book being published, I rushed to Amazon to order it.

This book will revolutionize the way we look at surgery and medicine. My husband chose "watchful waiting" when he was diagnosed with prostate cancer 10 years ago and his care also was supervised at Johns Hopkins. (Yes, we live 4+ hours from Baltimore.) Tonight on PBS, a program talked about the many medical mistakes that happen when a patient is overtreated and not told what his/her options are for surgery. This is what Dr. Makary says in this outstanding book, Unaccountable. This book is NOT just for doctors and administrators. If the public becomes educated and then speaks out for transparency in health care and hospitals, we will be helping the wonderful doctors who are advocating for the same thing! Let's get join together to save lives, money and quality of life. Thanks, Dr. Makary, for this book.
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