Health Care’s Lack Of Transparency
OPINION -- I had the pleasure of meeting Dr. Marty Makary, a surgeon at the Johns Hopkins Hospital and Associate Professor of Health Policy at the Johns Hopkins School of Public Health, a number of weeks ago in New York City.
I was so impressed with the good doctor that I read his book, Unaccountable—What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, on the plane back to the West Coast.
It was a book I wish I had penned. Dr. Makary dedicated his book to his father, whose compassion in the care of cancer patients inspired him to be a doctor and share his story. I thought of my colleague, Julie Doberne, an MD/PhD Candidate at the Oregon Health & Science University School of Medicine in my cohort in the PhD program who speaks of her desire to be a physician working with electronic health records (EHR) ever since she was a little girl following her physician father around while he was doing rounds in a hospital that had an EHR system many years ago. She seems to have that same passion Dr. Makary has for practicing medicine.
Dr. Makary led the efforts of the World Health Organization to measure hospital performance and was the first to publish studies on the use of a checklist in surgery. Of course, airlines have had checklists for many years.
Dr. Makary’s book is quite insightful. The question is: Are you risking your life when you go into a hospital? Apparently, one study found that one in four patients was harmed by medical errors. Dr. Makary seems to tell it like it is:
The physician who called in another physician who could remove a polyp in a colon through a wire snare in the scope, compared to one who chose to take out part of the colon.
The world-renowned physician who operated out of his scope of expertise, allegedly resulting in the death of a head of state.
Physicians who do not know how to use the newest equipment or are not schooled in the newest procedures, and who do not tell a patient that he or she could go to another hospital where such equipment or skill exists.
He mentions Fred Flintstone care—doctor speak for outdated medicine. He notes that only a percentage of patients are offered minimally invasive surgery. He comments on impaired physicians practicing medicine, medical mistakes not being reported, and nonprofit healthcare fundraising where CEOs make millions of dollars a year, while children collect pennies for the institutions. Dr. Makary discusses fee-for-service medicine and needless surgeries.
He discusses what accountability looks like and what changes might look like in his Online Dashboard. He discusses bounce backs (what percentage of hospitalized patients are readmitted to a hospital in ninety days), complication rates (any unexpected adverse event that develops during or after a medical treatment or procedure), never events (things that should never happen in a hospital), safety-culture scores (e.g., would a healthcare worker at a hospital have an operation where he or she works?), and hospital volumes (how many patients with a particular medical condition are treated each year and what type of surgery they had). In addition, he discusses transparent records, open notes, and video recording.
In Dr. Makary’s ideal world, one with much transparency, we should be able to significantly increase quality and decrease costs. The good doctor’s book is a must-read for those interested in how our healthcare system might be improved.
Paul R. DeMuro JD, CPA, MBA, MBI, Schwabe, Williamson & Wyatt, PC, National Library of Medicine, Post-Doctoral Fellow in the Ph.D. Program with Oregon Health & Science University.