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The bad news about good medicine

By Jay MacDonald ·
Tuesday, October 2, 2012
Posted: 10 am ET

If you believe that health care reform is unnecessary, that health insurance is reasonably priced and that America's medical system is the best in the world, you may want to check in with Dr. Marty Makary.

Makary, a surgeon at Johns Hopkins Hospital and professor of health policy at Hopkins' School of Public Health, led a World Health Organization initiative to find standardized ways to measure the quality of the medical care we receive. He's also the author of the new book "Unacccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care."

What Makary says he found behind the scenes of your esteemed local hospital makes "Unaccountable" read more like a ticking-clock thriller than a sobering face-slap of facts from a guy who thinks you should know what you're getting into, especially if you're contemplating elective surgery. A sampling:

  • Studies show that 1 in 4 patients are harmed by medical errors.
  • U.S. surgeons operate on the wrong patient or body part as often as 40 times a week.
  • The number of patients killed by preventable medical errors in the U.S. every year is equivalent to four jumbo jets crashing each week.
  • In a confidential survey of U.S. hospitals, staffers were asked, "Would you feel comfortable having your own care performed at this hospital?" At a third of those hospitals, more than half of staff answered, "No."

"One of the big issues that historically we have not talked about in modern medicine is overtreatment and just bad-quality medical care," Makary told me in a recent phone chat. "There is good research now that shows that 20 to 30 percent of what we do, all the medications we give and the procedures we do, are unnecessary."

Makary blames these disturbing findings on a dysfunctional medical culture in which: the payment system for doctors leads them to prescribe unnecessary procedures; a lack of patient coordination results in redundant tests and procedures; and patients are both left out of the loop and stuck with higher health insurance premiums.

"Doctors feel like they don't have any control over (the culture) because, let's face it, hospitals have become giant corporations," Makary says. "Last year, there were a record number of hospital mergers and acquisitions in the United States and many people are noticing their little community hospital has now become part of a 10-hospital network run by a CEO who looks in many ways like a Wall Street guy. The incentives are not properly aligned with what's in the best interest of the patient. The docs and nurses often can tell you what needs to be done differently but they feel disempowered."

What's the solution? Makary says that while health care reform is "terrific in principle," only by standardizing and measuring hospital performance, making the findings public, and demanding accountability will we bring skyrocketing U.S. health care costs back to earth.

"I'm convinced that the government regulators and even insurance companies are not going to fix the problem," Makary says. "It's going to take transparency and local solutions based on local wisdom at the hospital level, not some outside force that imposes it."

Pop quiz: How would you make health care more accountable?

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