31 of 41 people found the following review helpful
This review is from: Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care (Hardcover)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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Initial post: Dec 8, 2012 11:24:28 PM PST
Last edited by the author on Dec 9, 2012 12:09:58 AM PST
I have not read Dr Markary's book. I did hear him express his position on Book TV channel. I will probably not have time to read his book. My comments are based on clinical experience in the trenches of community medicine not a brief ivory tower experience and would follow closely those of "scribe", who also is a physician as am I with many more years of experience than this author. He may be well-intentioned, but his efforts to improve care by "increasing transparancy" and accountability, may result in much more suffering and misery for patients. The medical profession already has a problem with burgeoning 90% of lawsuits by aggressive medical litigation lawyers undermining patient's confidence. The practice of medicine also has quite enough monitoring from professional peer review, hospital morbidity and mortality reviews and patient self reporting in their communities, not to mention state board medical licensure measures. We should be trying to assist physicians not harrass them to the point where their effectiveness in delivering care is compromised.
OB/Gyn Fellow, American College OB/Gyn 1968, Fellow Cental Asso. OB/GYN 1970
In reply to an earlier post on Dec 16, 2012 10:10:30 AM PST
How to practice medicine: Observe and question patient. Determine differential diagnosis. Formulate treatment plan. Check on effect of treatment. Do this yourself rather than through a nurse or PA. If you are unhappy inn your work, seek employment as a sanitation worker.
Health care workers are not educated, they are trained. There is a difference.
In reply to an earlier post on Feb 25, 2013 1:25:22 PM PST
I would recommend you read Dr. Markary's book. Your comments really are not germane to the subjects he covers, which to me (having read the book and having spent most of my career working in healthcare) are sound and reasonable.
In reply to an earlier post on Feb 25, 2013 2:43:34 PM PST
I started a reply, then pressed the wrong button and lost it.
Suffice to say I also worked in healthcare for many years, and have had some interesting experiences both working with physicians and as a patient.
I'll try the book. Maybe I'll feel better.
In reply to an earlier post on Feb 28, 2013 10:28:07 AM PST
Last edited by the author on Feb 28, 2013 10:29:12 AM PST
I understand what you have written and don't really have to be told how to practice and to check on methods as you advised in your email of Dec. 16. You have not addressed the issues I raised in my post.
In reply to an earlier post on Feb 28, 2013 11:26:30 AM PST
My point was that if the medical profession would get back to the basics (I have encountered, both professionally and personally, too many who don't care for them) books of this sort might be superfluous.
In fairness to myself and you, I should say that I was not a practitioner but an all-too-close observer, a writer. I worked with many good and honorable people, and too many who shocked me. I often think of the old joke that medicine would be a great way to make a living if it weren't for the patients -- of which I am unfortunately one. Believe me, I have experienced my own share of checks and balances -- some helpful, too many by people who couldn't even begin to comprehend the professional standards I applied to my work,
The calling of physician is simply too high for many human beings. No amount of oversight can change that. I sympathize -- and empathize -- with those who day after day try to do the right thing only to be plagued by -- what to call it?
Naturally, what the layperson gets is largely the bad news -- I don't have to tell you what that is. But it's enough to make one cynical and afraid of finding oneself under the thumb of a practitioner with just that touch of I-couldn't-care-less. Recently I was subjected to an office procedure that had me screaming at the top of my lungs with pain. I even overheard one of the personnel comment that it should have been done under anesthesia. What was this guy thinking? What are any of you guys thinking?
I'm researching means of suicide.
In reply to an earlier post on Mar 27, 2013 9:55:17 AM PDT
M. Twain says:
Of course, less transparency is the answer. Keep it hidden from the patients, right? Keep it quiet! You are the the problem doctor. The fact that you are worried more about your liability over the patient care speaks volumes and is a major reason why we have a problem with so many lawsuits. In your world patient care doesn't come first--doctor care does. Go back to counting your money.
In reply to an earlier post on Mar 28, 2013 12:15:09 AM PDT
To M. Miller
Mr. Miller you seem to have forgotton to address any of the issues I raised. What are your qualifications for judging doctors?
In reply to an earlier post on Mar 28, 2013 8:35:42 AM PDT
If you mean Moyer, not Miller. my qualifications are nearly 30 year of working with doctors in various specialties.
In reply to an earlier post on Mar 28, 2013 8:44:09 AM PDT
I agree with Miller -- sorry for the ID misunderstanding.
Ever hear the one about the doctor who bent the statistics in his study to make the results come out "right" -- after three previous analyses by others failed to satisfy.
You can do your own research by simple observation. You'd be amazed at what you can see when you look.
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