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A former congressman reveals the need for a U. Government Chief Financial Officer to keep government spending in check and calls for truth in goverment and an end to deceptive budgeting practices. Skip to content. 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. 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. From the collectors at communal granaries in the ancient Middle East to the scribes who monitored Queen Victoria's Exchequer, the accountant's role has been to preserve the integrity of financial systems. In the United States, twentieth-century accountants played a vital role in shaping the transparency of U.
Yet by , the reputation of the public accountant was in tatters. How did the accounting profession in America squander its legacy of public service? What happened to the accountants that presidents, senators, and captains of industry turned to for advice? Why did auditors stop looking for fraud? How did this once revered profession find itself in this unlikely and humiliating state?
Makary considers multiple aspects of this problem in terms of medicine being unaccountable. His book explains what he means by this, including poor treatment climates, excessive or inappropriate care, medical mistakes, and even the wide variety of approaches for treating conditions that can range from major surgery, to less invasive surgery, to non-surgical and lifestyle options. What can patients do to improve the odds that their treatment choices are well considered and not the result of a crap shoot, a bad time of day, or even a scheduling issue that has not doctors out of the hospital on the days when surgery is sought?
Of course one can ask about these issues, and many more, that are detailed in the book. The trouble is that, even if one asks, the information even if available is not available to patients or to the general public. It is difficult to tell whether the hospital you wish to go to or the physicians you want to patronize or more or less skillful and careful. It is difficult to find out what is what.
This is a scary condition to read about and it is ongoing today. Makary is wonderful and noting and explaining the issues and in informing readers what they can do to try to prepare themselves for care. But part of the answer lies in patients being their own manager for their own care, even if that involves asking lots of questions to intimidating looking health care professionals and administrators.
But if a patient or family member does not do this, it is hard to see how someone else will do it for them, short of some amazing good luck. Everyone who anticipates personal contacts with the healthcare system but either themselves or their family members should read this book, even though it is not necessarily a feel good message.
This is a great book that will assist people in figuring things out. Extremely well-written and informative. Glad to have read this! Jun 11, Shreya rated it it was amazing. Yet another text that should be required reading at health professional schools.
Highlighted throughout. Oct 26, Jerry rated it really liked it Shelves: science. This book is well worth reading to learn about some very sensible proposals for improving and reducing the cost of health care. The key point is transparency. By doing so, it will unleash the power of the free market to cre This book is well worth reading to learn about some very sensible proposals for improving and reducing the cost of health care.
By doing so, it will unleash the power of the free market to create positive change. When hospitals have to compete on a level playing field, all of them will be forced to improve how they serve their patients. As a result, expensive gadgets that may have no clinical benefit can be rapidly adopted.
In the case of surgical robots, its an arms race. The surgical robot perfectly symbolizes how our widespread adoption of new, high-tech solutions without proper evaluation of their benefits is breaking the bank. One highly cited study showed that approximately half of all cancer patients received chemo or radiation treatment the same week as their death Cancer centers have become profit centers for hospitals, thanks to the increasing number of services they prescribe and the surcharges added to the price of chemotherapy drugs Whenever confronted with a decision about your medical care, inquire about the difference in average outcomes and the quality of life among the options.
This is a well-known bias in the literature that in the medical community is called publication bias. It refers to the fact that only doctors with low complication rates dare submit their results to medical journals Dec 26, Vertrees rated it did not like it. I am completely appalled at the section on Walter Reed.
The gross inaccuracies, misleading information, and lack of attention to detail of that section casts the entire book in doubt. My second problem- Dr. Marohn was I am completely appalled at the section on Walter Reed. Marohn was assigned to Andrews AirForce base.
He would come to Walter Reed very infrequently I saw him there in a case in to help with a case. And he was supposed to have complained about it? I call Bull. I looked up that survey searched 'hospital safety culture survey' on Google. One thing we can agree about- I wish the survey had been completed. I worked there from except for the time i was deployed to Afghanistan. Morale was good, and the actual impatient care what would be tested by the survey I am sure would have been rated highly.
I am proud of the work that we did there. There was truly first-rate medical care for our soldiers. But unlike the article, I recognize that those problems are beyond the scope of this book and would not be addressed by his referenced survey.
What I took away from that section is that he jumped on the bandwagon of a sensationalized story without doing adequate research. Did he even read the article? He then takes a statement from a colleague at his workplace - as he notes, down the street from Walter Reed- rather than asking someone who works at Walter Reed.
He flippantly says that this magical survey could have fixed bad hospitals like Walter Reed. Check the details- it took me a couple of minutes using his information to completely discredit his argument. After such sloppy work- how can we believe anything else?
It's too bad bc I think the point of transparency in healthcare is an excellent one, and needs to be accurately addressed in a manner we can trust has been researched with attention to detail rather than sensationalism.
View all 5 comments. Oct 22, Dan rated it really liked it. Makary says that transparency is the key to reducing the cost of health care in the US and improving the areas in which US health care has results worse than many other countries. Driven by the profit motive and free from any scrutiny by patients or the general public, hospitals have reacted to maximize profit rather than patient welfare.
He cites such problems as incompetent doctors all medical students pass medical school regardless of grades , impaired doctors those under the influence Dr. He cites such problems as incompetent doctors all medical students pass medical school regardless of grades , impaired doctors those under the influence of drugs or alcohol or suffering from senile degeneration of various kinds , and the atmosphere of covering up for other doctors' mistakes as being prevalent in all hospitals.
These sections of the book serve to educate the patient as to what to expect and ways to become informed before blindly submitting to prescribed treatment.
Fortunately, Makary does not stop with pointing out the problem. He goes on to propose a solution--transparency. He advocates that all hospitals publish their "dashboard" with six statistics: 1 bounce backs: the percentage of patients readmitted within ninety days; 2 complication rates; 3 never events--events that should never happen, e.
He cites examples of successful use of each of the six steps he recommends. I highly recommend this book to everyone affected by the US healthcare system regardless of your views on the role government should play in healthcare. The measures Makary advocates can be administered and overseen by healthcare industry organizations.
He is not pushing government regulation. Oct 02, Rachel rated it really liked it Shelves: culture-studies , nf , medicine. In fact, as Dr. Makary discusses, this is one logical consequence of a system that makes up a fifth of the nation's economy yet goes largely untaxed and unregulated, and sees profit from every procedure undertaken, necessary or not. Advocating for transparency in data such as doctor ratings, number, type, and outcomes of procedures performed, and safety indicators such as employee perceptions of teamwork, comfort level bringing up problems to superiors, and percentages of hospital staff who would want their own treatment administered at the facility where they work, he makes the argument that patients will have to wield their power as consumers to demand accessible and decipherable information enabling them to take more control of their own care.
It's a grand vision for a complicated system, but one Makary argues an up-and-coming generation of doctors themselves are getting behind. Feb 27, Ariadna73 rated it it was amazing Shelves: health-and-health-care. The author is an oncologist at John Hopkins. He talks about dr. Hadad Hands of Death and Destruction there are quite a lot in our system. It tells horror stories of doctors that are reckless and treat their slept patients as garbage.
They rely on the blissfulness amnesic powers of the anesthesia and know that the patient won't remember a thing of the mistreats they are subjected to. Doctors have no heart. They have big wallets in the middle of their chests; but sometimes the system starves tho The author is an oncologist at John Hopkins. They have big wallets in the middle of their chests; but sometimes the system starves those wallets so badly that they keep no feelings at all.
They keep prescribing expensive treatments and surgery necessary only to put more money in those wallets; but not for the well being of the patients.
And the worst of all is that when the patient wakes up; he or she is so grateful with the doctor; that sends the physician flowers and thank you cards. Even the author; mr Hopkings confesses to these flaws. It is not because they are bad persons; it is because they are human and they need to eat and also pay for a few toys; so they really need to make money by using all that new and expensive technology May 07, Ethan rated it really liked it.
Compelling - if occasionally disjointed - case for how transparency of hospital quality and outcomes metrics could greatly improve health care in the USA. Skirts any mention of cost transparency, also omits describing how most doctors are not actually employees of the hospitals he proposes making more accountable.
But the descriptions of nascent efforts in quality reporting are powerful, along with the idea that health care can only get better - and quickly!
Nov 03, Deann rated it it was amazing. I was impressed by level of honesty expressed by Dr. It was well-written and exposed the dreadful situation in many American hosptials. This book has the potential to be our generation's The Jungle; it is a wake up call to make our hospitals safer and more transparent about how our healthcare and taxpayer dollars are spent. A must-read for anyone before undergoing any major medical treatment!
Feb 26, Sharon Dewit rated it it was amazing. Amazing to read. Talks about how robotic surgery is NOT an improvement. Talks about how little we really know about our hospitals and how in the dark we are. Discusses things that will make you angry and sad. How have we allowed medical care to be about the dollar and not the patient? Why should we ever allow this to continue? A must read for anyone who might ever be a patient or the loved one of a patient.
Wish it was required high school reading! Jun 04, Emily rated it it was amazing Shelves: medical. Between my summer experiences and this book, my med student idealism has been thoroughly and vitally smashed.
But from the pieces, I find myself now able to better construct a new and realistic outlook on the current state of medicine as well as where I'd like to take it in my future practice. This is an important book for anyone in the medical profession, as well as anyone interested in having the tools to be their own best advocate as a patient.
Oct 03, Pamela rated it really liked it. A tipping point is imminent and full disclosures of practices in medicine will result in saved lives, reduced costs and the integrity of a serving profession. I highly recommend this book. Apr 26, Geoffrey Rose rated it really liked it. A call to arms for greater transparency in health care. A solid primer on the importance of better patient safety culture for the health care professional and general reader alike. Strongly recommended. Sep 08, Elizabeth marked it as to-read Shelves: science-and-medicine.
As seen in Nature. Sep 19, Megan rated it it was amazing Shelves: non-fiction. Fascinating read about hospital culture and the need for change. Sep 21, Elise rated it it was amazing. Sep 25, Danielle marked it as to-read Shelves: society. Oct 02, Jessica Santos rated it really liked it.
A must-read for any health care consumer or affiliate. Books like these will help change our broken health care system into something better.
Sep 28, Joe rated it it was amazing. Selected quotes: " He realized that hospitals get more money for each complication, X-ray, and extra patient day in the ICU. One well-known national study Wow.
One well-known national study Big, broad improvements in mortality, statewide. Download for offline reading, highlight, bookmark or take notes while you read. The modern American hospital is that establishment and Unaccountable is that book.
Makary can testify to the amazing power of modern medicine to cure. Get this from a library! Unaccountable what hospitals won t tell you and how transparency can revolutionize health care. 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
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