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Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care Kindle Edition
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Over the last ten years, quality of care remains highly variable, despite remarkable scientific progress. To patients, the healthcare system is a black box. They are unable to navigate where to go. Patients need to know more of what healthcare workers know, so they can make informed choices.
Unaccountable is a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system.
- LanguageEnglish
- PublisherBloomsbury Press
- Publication dateSeptember 18, 2012
- File size4785 KB
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Editorial Reviews
About the Author
Dr. Makary also serves as executive director of Improving Wisely, a national physician collaboration to reduce unnecessarymedical care and lower health care costs. His current research focuseson the appropriateness of medical care, administrative waste, price andquality transparency, and the impact of health care costs on low-incomepopulations.
Dr. Makary was the lead author of the originalarticles on the Surgical Checklist and later served in leadership withAtul Gawande on the World Health Organization Surgery Checklist project. Makary has published more than 250 scientific articles, includingarticles on payment reform, vulnerable populations, and opioidprescribing guidelines. He is also an advocate for treating medicalconditions when possible with healthy foods and lifestyle medicine. Dr. Makary has been named one of America's 20 most influential people inhealth care by Health Leaders magazine.
Review
Review
"A galvanizing book full of shocking truths about the current state of healthcare."
-- "Kirkus Reviews""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""This thought-provoking guide from a leader in the field is a must-read for MDs, and an eye-opener for the rest of us."
-- "Publishers Weekly"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.-- "Booklist" --This text refers to the audioCD edition.
Product details
- ASIN : B008RYD43G
- Publisher : Bloomsbury Press; 1st edition (September 18, 2012)
- Publication date : September 18, 2012
- Language : English
- File size : 4785 KB
- Text-to-Speech : Enabled
- Screen Reader : Supported
- Enhanced typesetting : Enabled
- X-Ray : Enabled
- Word Wise : Enabled
- Sticky notes : On Kindle Scribe
- Print length : 257 pages
- Best Sellers Rank: #613,142 in Kindle Store (See Top 100 in Kindle Store)
- #83 in Pathology Clinical Chemistry (Kindle Store)
- #427 in Pathology Clinical Chemistry (Books)
- #3,016 in Professional & Technical
- Customer Reviews:
About the author

Dr. Makary is a Johns Hopkins surgeon and Professor of Health Policy & Management. He is a leading voice for physicians writing for the Wall Street Journal and USA Today and is a member of the National Academy of Medicine.
He is the founder of Restoring Medicine, an advocacy effort to help people who can’t afford their medical bills. Dr. Makary also serves as executive director of Improving Wisely, a national physician collaboration to reduce unnecessary medical care and lower health care costs. His current research focuses on the appropriateness of medical care, administrative waste, price and quality transparency, and the impact of health care costs on low-income populations.
Dr. Makary was the lead author of the original articles on the Surgical Checklist and later served in leadership with Atul Gawande on the World Health Organization Surgery Checklist project. Makary has published more than 250 scientific articles, including articles on payment reform, vulnerable populations, and opioid prescribing guidelines. He is also an advocate for treating medical conditions when possible with healthy foods and lifestyle medicine. Dr. Makary has been named one of America’s 20 most influential people in health care by Health Leaders magazine.
His newest book The Price We Pay speaks to the heart of American Medicine's public trust--a trust being eroded by the high cost of care. Described as “a must-read for every American” by Steve Forbes and a “deep dive into the real issues driving up the cost of health care” by Dr. Don Berwick, The Price We Pay is the “The Big Short” of American Medicine.
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A bad fall in a blizzard sent my otherwise healthy as an Ox father into the ICU. Within days he made huge improvements that surprised the doctors. The physical therapist stated that he doesn't expect him to be with them for long because he was doing so well. The day he was to go to the recovery room my mother noticed he didn't look right. The nurse came by hourly to check on him and look at his levels to put into the computer-- but for some reason she nor any of the doctors failed to noticed that for the past 10 consecutive hours, his oxygen levels kept slipping to dangerous levels. My family asked the nurse to get a doctor because he didn't seem right (the nurse thought he looked fine) but she left and much later (after asking again for a doctor) she came back with a respiratory therapist instead. Soon my father started making weird noises. My brother in law screamed for the doctor. Next thing we know, every doctor rushed into the room and my family were kicked into the hall scared to death. What the hell just happened? He was fine last night!
Long story (not so) short: we were told his brain herniated and collapsed! No explanation as to why or how because they had no idea. They actually told me that they had never seen this happen to anyone before. What was also interesting was that every doctor that we saw every day that checked up on him every day made sure to mention to us NOW that they weren't actually his "real" doctor. At the end of that emotionally draining day (and me being in complete denial) I had no idea who his damn doctor was anymore. We requested to have a sit down with the nurse. The head RN said they would interview the young nurse for her point of view of what happened and discuss it with us, however they quickly changed their minds and didn't want to discuss anything anymore. Obviously they were concerned with protecting her. Meetings with the doctors- they told us they felt his cause of death was due to unknown factors but one in which was not related to the injury that brought him to the hospital. They were still at a total loss as to how his brain literally collapsed taking the brain stem with it. They had their "theories" of a stroke or a vasovagal attack, but those where dismissed during the independent autopsy which if anything, was a declaration of how wonderful and strong my father's health had been prior.
We were able to find an alternative neurosurgeon doctor from another state look at the reports and he was actually surprised that he saw enough information to declared negligence.
When the hospital was taken over by *** I read that all the pursuing changes they made were unacceptable to the established and experienced nurses who, in a short amount of time, all left their jobs for other hospitals. Enter the new nurses, young, inexperienced, and willing to work for what the established nurses would not. This may be an unpopular opinion but during the time when everything seemed to be looking up, I noted how all the nurses in the ICU looked like they were barely out of high school. Why would such inexperienced nurses be in the ICU working alone. I asked each one of them how old they were and how long they were working as a nurse. The average was 22 years old with less than 1 year of experience. Fact is, at that stage you are literally in the entry level stage of you career. I know enough nurses that have told me that at that age they don't have the guts to speak up to a doctor. I want to know why the nurse brought a respritory therapist when we specifically requested a doctor. I also want to know why we had to ask her two times before she brought anyone (yes she did actually left the room making us think she would bring the Dr). Even then, it was my brother in law that screamed and demanded the doctor to come. Then I want to know why she had access to my fathers vitals for the entire night and didn't notice his oxygen levels going down every hour? They won't tell us. 2 years later, we are still suffering without him and we still have so many questions. I feel like I failed him by not moving him to another hospital where I just know in my heart he would have been able to walk out of.--- So for those of you that want to give the professionals the benefit of the doubt -- don't! It's your loved ones so please speak up. Ask questions all the time. My dad came into the hospital with blood in his brain. They were aware of this. The next day the blood was less. I asked about surgery. I was told they would wait to see where it would go. Well it went into a catastrophic event. I look back and wish I begged, demanded, screamed, for them to perform a surgery on my dad. If the blood is there where does it go? His brain swole and that's what caused the herniation.
I apologize for carrying on but it's still painful and I don't want anyone to go through what we are going through. It never ends. He's been buried for 2 years but the pain never ends. --- Good luck to everyone out there and tell your family you love them. Better to be cautious than worry that your annoying the doctor.
Written by a surgeon who specializes in pancreatic cancer, "Unaccountable" is a first-person narrative about what is broken in our hospital system by someone trying to improve things from the inside. I cringed while I was reading this book: Marty Makary recounts several painful instances of when he was a medical school student and young doctor and he knowingly went against his own conscience and the Hippocratic Oath in order not to lose standing among his peers and superiors. At the time he could not find a voice to advocate for safety, caring more about his job, and the opinion of his colleagues, than he did about doing what was right, safe, and best for patients. Makary allowed a young woman to get a botched breast reconstruction without ever informing her that a nearby hospital had more experienced surgeons, used a better procedure, and could have done a much better job; he says nothing when his colleagues lie to an elderly man in order to convince (or maybe browbeat would be a better word) him to agree to an operation he does not want and should not have.
At the same time, it is clear from his book that he feels deep remorse about the silence he maintained and he writes about it to show how hard it is for doctors, especially young doctors but really all doctors, to speak out when they know something is wrong. The unspoken code in the medical profession is to blame doctor error on "bad luck," to excuse doctors who have temper tantrums, and cover up for doctors who are alcoholics or drug addicts. In order to change this, Makary argues repeatedly in the book, we need transparency in American hospitals. Americans need to realize that hospitals -- and our entire health care system -- is a for-profit business and that they themselves are consumers. They need to do as much research as possible, educate themselves about overtreatment, and consider all their options. They need to ask their doctors difficult questions. If they don't like the answers, or if the doctors refuse to answer, they need to take their business elsewhere.
The most telling parts of the book are when Makary describes how he himself was treated when his brother was hospitalized (as a nuisance) and how his medical colleagues who had health problems were treated when they became patients and were no longer in charge. One of the doctors Makary admired tremendously left medicine. That colleague's personal experience receiving bad care was part of what catapulted him out. Trusting his doctors without question, he agreed to back surgery he probably did not need. A completely botched operation that left him more incapacitated and in greater pain, a pain he will probably have for the rest of his life.
Every American who has ever been to a doctor or has ever been hospitalized needs to read this book. Every doctor in America needs to read it as well, and every medical school student. I hope that books by doctors like "Unaccountable," "Born in the U.S.A." (Marsden Wagner, M.D.), and "The Color of Atmosphere" (Maggie Kozel, M.D.), along with investigations like Steven Brill's Time Magazine cover story "Bitter Pill" and my exposé of how corporate greed and for-profit medicine harm new moms and babies, "The Business of Baby," will inspire all of us to demand more accountability and a safer, more patient-friendly health care system that is not based on profit.
Kudos to Marty Makary for telling the truth about his own mistakes and the mistakes of his colleagues. Kudos to him for breaking the code of silence that keeps impaired doctors practicing medicine when they should not be; for insisting on digital videotaping of every operation; sharing his notes with patients at the end of a visit and inviting them to correct any mistakes or misunderstandings; and encouraging patients to take charge of their health. It is time to put an end to the obfuscation, impaired doctoring, and poor outcomes. We deserve a better health care system in this country. The time is now. Read this book.





