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

by Marty Makary (Author)
4.7 4.7 out of 5 stars 737 ratings
See all formats and editions
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Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting. Over the last ten years, neither error rates nor costs have come down, despite scientific progress and efforts to curb expenses. Why? To patients, the healthcare system is a black box. Doctors and hospitals are unaccountable, and the lack of transparency leaves both bad doctors and systemic flaws unchecked. Patients need to know more of what healthcare workers know, so they can make informed choices. Accountability in healthcare would expose dangerous doctors, reward good performance, and force positive change nationally, using the power of the free market. Unaccountable is a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system.
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  1. Print length
    256 pages
  2. Language
    English
  3. Publisher
    Bloomsbury Press
  4. Publication date
    September 18, 2012
  5. Dimensions
    6.45 x 0.88 x 9.55 inches
  6. ISBN-10
    1608198367
  7. ISBN-13
    978-1608198368
  8. See all details
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Editorial Reviews

Review

“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. Most recently he appeared on FOX News Reporting: BEWARE! DANGER AT THE DOCTOR. He is a leading patient-safety researcher and led the World Health Organization effort to develop ways to measure healthcare quality. He tweets @DrMartyMD.

Product details

  • Publisher ‏ : ‎ Bloomsbury Press; 1st edition (September 18, 2012)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 256 pages
  • ISBN-10 ‏ : ‎ 1608198367
  • ISBN-13 ‏ : ‎ 978-1608198368
  • Item Weight ‏ : ‎ 15.3 ounces
  • Dimensions ‏ : ‎ 6.45 x 0.88 x 9.55 inches
  • Customer Reviews:
    4.7 4.7 out of 5 stars 737 ratings

About the author

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Marty Makary MD

Marty Makary MD

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Dr. “Marty” Makary is a Johns Hopkins professor and 3-time NYT bestselling author. His newest book, BLIND SPOTS looks at the latest scientific research on topic that we are not talking about (that we need to talk about):

▶ The Microbiome

▶ Hormone Replacement Therapy

▶ The Peanut Allergy Epidemic

▶ Eggs (& Food)

▶ Blood tests not being ordered everyone needs

▶ Childbirth

▶ Cancer Prevention

▶ Marijuana

▶ The Culture of Medicine

▶ Medical Dogma

Dr. Makary has been a visiting professor at over 25 medical schools, has published over 300 scientific peer-reviewed articles, and has written for the Wall Street Journal, the New York Times, and the Washington Post. A public health researcher, Dr. Makary served in leadership at the World Health Organization and is a member of the National Academy of Medicine.

Dr. Makary is the recipient of the 2020 Business Book of the Year Award for his book, The Price We Pay, about the grassroots movement to lower healthcare costs through greater medical transparency. He currently leads the Evidence-based Medicine Public Policy Research Group at Johns Hopkins and is director of The Re-design of Healthcare Project, a national effort to make health care more reliable and affordable, especially for vulnerable populations. His research focuses on the appropriateness of medical care, administrative waste, and the impact of health recommendations on society. Dr. Makary is the recipient of the Nobility in Science Award from the National Pancreas Foundation and numerous teaching awards. His newest book, Blind Spots, details how to live healthy by separating medical dogma from evidence-based science.

Customer reviews

4.7 out of 5 stars
737 global ratings

Customers say

Customers find the book very informative, eye-opening, and interesting. They also describe it as a great read, helpful for health care professionals, and enjoyable to read. Readers appreciate the honesty, candidness, and compelling eye witness accounts. However, some feel the book is unaccountable at all levels.

AI-generated from the text of customer reviews

Select to learn more
Information qualityReadabilityReadableHonestyScariness levelEye openingStory qualityAccountability
81 customers mention "Information quality"78 positive3 negative

Customers find the book very informative, eye-opening, and easy to read. They say it provides great insights into the problems of modern day medicine as practiced in America. Readers also appreciate the author's astute and courageous doctor. In addition, they say the book gives concrete suggestions about researching hospitals for various types of procedures.

"...Wouldn't they have known who to go to? Nevertheless, an interesting, thought-provoking read." Read more

"...I do believe the author did a nice job of covering a difficult subject...." Read more

"...Other than the comment about tort reform, I felt Dr. Makary's insights were helpful and balanced...." Read more

"...subtopics are nicely compartmentalized into chapters; the subtopics are each important, well explained, well discussed, and well illustrated with..." Read more

62 customers mention "Readability"62 positive0 negative

Customers find the book interesting, amazing, and helpful. They say it's worth reading for health care professionals and systems thinkers. Readers also mention it's valuable.

"good book" Read more

"...Worth the money and time spent reading!" Read more

"This book is worth reading for health care professionals, systems thinkers, CQI professionals, health policy experts, politicians, and the general..." Read more

"I give very few five star ratings, but this book is truly outstanding, eye-opening and readable...." Read more

45 customers mention "Readable"37 positive8 negative

Customers find the book very readable, engaging, and enjoyable to read. They say the writing is clearly stated and there are no typos or grammatical mistakes. Readers also mention the suggestions are simplistic and clear.

"...The book didn't always flow but it was an easy read and once I started it I just kept reading......" Read more

"Very thought-provoking look at the medical industry which makes up 1/5 of our economy. Much of this, I suspected already...." Read more

"...The book is very well written; I saw no typos or grammatical mistakes; the subtopics are nicely compartmentalized into chapters; the subtopics are..." Read more

"...It is a popular book rather than scholarly. It is easy to read, but is not designed as a reference...." Read more

15 customers mention "Honesty"15 positive0 negative

Customers find the book honest, candid, and transparent. They say it's believable, compelling, and courageous. Readers also mention the eye witness accounts are compelling.

"Frightening and very real...." Read more

"...An important and courageous statement by an insider...." Read more

"Dr Makary is so honest...." Read more

"...having worked with HODADs and Raptors in my life, the accounts were very believable. This is a book that everyone should read...." Read more

8 customers mention "Scariness level"6 positive2 negative

Customers find the book scary on one level and reassuring.

"I have no doubts that it is the most frightening book I had ever read...." Read more

"...This was truly eye opening. It was scary on one level and reassuring that Martin Makary was willing to share this insight on the other...." Read more

"...book are quite funny for the surgeon reader, and likely very shocking to the lay reader...." Read more

"...Go to another town if you have to. This was frightening and informative. Not an easy read." Read more

4 customers mention "Eye opening"4 positive0 negative

Customers find the book eye-opening, thought-provoking, and insightful. They say it provides an interesting look into behind-the-scenes health care.

"...This was truly eye opening. It was scary on one level and reassuring that Martin Makary was willing to share this insight on the other...." Read more

"Arrived on time and in perfect condition. Very intersting look into behind the scenes health care. A book that all in health care should read." Read more

"Thought provoking and sightful..." Read more

"READABLE... FACINATING AND VERY INSIGHTFUL FOR ANYONE ......" Read more

8 customers mention "Story quality"5 positive3 negative

Customers have mixed opinions about the story quality. Some mention it's clearly written, a true adventure story, and interesting. Others say it's slightly repetitive and meandering.

"Excellent book. It is clearly written, a true adventure story, and filled with critical information...." Read more

"...appears dedicated to this cause, but the result is a somewhat repetititve story line...." Read more

"Enjoyable to read with a good mix of story and cited authority. Every consumer should read and then use it to advocate for change" Read more

"This book starts with a great premise - accountability should help improve our ability to direct our health care choices...." Read more

15 customers mention "Accountability"0 positive15 negative

Customers find the book unaccountable at all levels. They say it protects bad doctors, practices, and outcomes.

"...is that the health care industry hides and protects bad doctors, bad practices and bad outcomes...." Read more

"...I have no current complaints, but I do find the suggestion of unaccountability somewhat disturbing." Read more

"...view of how our healthcare system works today and the lack of accountability." Read more

"UNACCOUNTABLE should be read by EVERYONE..." Read more

Top reviews from the United States

CountryGurl
5.0 out of 5 stars Very good book
Reviewed in the United States on February 26, 2019
Verified Purchase
This book really explains how unaccountable the medical profession is today, and why that's a problem. I really liked a lot of the author's suggestions, like having all surgeries videotaped in the future and demanding patient outcomes be collected and publicized. But one of the main reasons why the medical profession is unaccountable today is because of tort reform, which makes it almost impossible to sue doctors and hospitals because there are caps on damages that make it not worthwhile for lawyers to take on malpractice cases. The book doesn't discuss that problem at all. The book also gives too much credit, in my opinion, to patient reviews on the internet (although, to be fair, the author doesn't give them much credit - but any is too much in my opinion). Doctors often have their staffs write glowing reviews, and some websites let doctors pay to remove the bad reviews or put them into a filter (these reviews sites are not trustworthy at all). The author makes the argument that the best way to choose doctors is by asking people who work in the medical profession. That may be true, but I'm not convinced because then he goes on to tell stories about some apparently very intelligent people in the medical industry who got botched themselves (sometimes horrifically), or their families' did. Wouldn't they have known who to go to? Nevertheless, an interesting, thought-provoking read.
27 people found this helpful
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James Bell
5.0 out of 5 stars About Time
Reviewed in the United States on November 13, 2024
Verified Purchase
As someone who has had many of the experiences described in the book, I can only say that it is about time. This book mainly deals with surgeries and therefore surgeons, but the ideas should also be used in non-surgical areas as well. This could include how many antibiotics and opioid meds prescribed by the practitioner. What is the referral rate of the doctor or NP to specialist care or the use of integrative type of care. I realize that we are talking about hospital care but these other disciplines do have expertise that you could shorten hospital stays and therefore help with health care costs.

Also, having openess between groups of doctors would advance the compassion felt between by all caregivers and their patients.

Dr. J. Bell
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MarLo
5.0 out of 5 stars We learned the hard way ! SPEAK UP !!!!
Reviewed in the United States on January 30, 2018
Verified Purchase
This book was recommended to me by a gentlemen who's elderly mother had brain damaged in her stay in the hospital. Here is my example of what happened. Please forgive me in advance for my writing as it is very difficult for me to leave out information that needs to be there while trying to minimize the actual situation to moments that are significant and forever stuck in my mind. I write this just so people will understand that they must be productive in asking questions and be vocal in what you want to say to the doctor. We made the big mistake of taking the word of the doctor(s) in the beginning because we had no medical experience. In this case of my beloved father, we all lived and slept in that damn hospital everyday 24/7 rotating our shifts. So we were able to see some of the things and the actual time the things happened that tried to be disputed later on.

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.
134 people found this helpful
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Sooner
4.0 out of 5 stars Excellent Read
Reviewed in the United States on October 20, 2012
Verified Purchase
I ordered Unaccountable the day it came out after seeing coverage on a healthcare blog I read. Having been involved with numerous healthcare organizations, it was a enlightening to see a physician take a stance about the state of healthcare involving other physicians. The book didn't always flow but it was an easy read and once I started it I just kept reading...

I do believe the author did a nice job of covering a difficult subject. There are some differences and difficulties in academic and community hospitals in addressing some of the items covered, but it doesn't take away the need for transparency and on-going pursuit to raise the bar on our US Healthcare System.

Worth the money and time spent reading!
3 people found this helpful
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judy
5.0 out of 5 stars good book
Reviewed in the United States on October 22, 2024
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good book
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Top reviews from other countries

Thor
5.0 out of 5 stars The dangers in what you don't know about hospital care
Reviewed in Canada on July 16, 2019
Verified Purchase
This book highlighted the extreme dangers we all face from hospitals which operate with zero transparency and accountability. Even a psychopath has some element of conscience, but not those working in and running hospitals. Learn about the language used to avoid the truth - no mistakes, only near misses - HA! No errors, only adverse events - HA! What you don't know about what is being done to you or your loved one may kill you and good luck, as this book points out - trying to get information about what goes on and what happens when things go wrong. Medical practice and hospital care operates with so much cover-up and legal protection, it is like a licence to kill. learn how to demand accountability and why you need it. Great read!
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Cliente Amazon
4.0 out of 5 stars Very interesting and easy to read
Reviewed in Brazil on September 7, 2016
Verified Purchase
As an investor in health companies in Brazil this book opened my eyes to many possobilities for health system improvements.
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Mr M. Pidd
5.0 out of 5 stars A depressing accouny of healthcare safety in the USA
Reviewed in the United Kingdom on August 26, 2013
Verified Purchase
A depressing accouny of healthcare safety in the USA written by someone deepply within the system who has much to say about how to put things right. The UK may not be the US, but his arguement has merit for the UK too.
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Renaissance Reader
5.0 out of 5 stars Excellent book that hits the point.
Reviewed in Canada on December 28, 2014
Verified Purchase
This book clearly addresses the issues of quality of care and outcomes in a clear and compelling manner. It not only diagnoses the problem but also presents some solutions. It is a must read.
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avidreader
5.0 out of 5 stars brilliant.
Reviewed in the United Kingdom on February 10, 2014
Verified Purchase
I wish people in the UK wrote as much about the NHS - what are we doing for transparency? This is a wake up call. And well written.
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