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Shedding Light on Surgery
Dr. Makary explores how transparency would improve patient care.
Marty Makary
Publish Date: May 22, 2014
OR Excellence
Marty Makary, MD, MPH, FACS Marty Makary, MD, MPH, FACS

Speaker Profile

  • Practices advanced laparoscopic pancreatic surgery at Johns Hopkins Hospital in Baltimore, Md.
  • Associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.
  • Pioneered research on the use of surgical safety checklists.
  • Author of "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care."

American medicine, the envy of the world, still sees such unthinkable errors as wrong-site, wrong-patient and wrong-procedure surgeries, retained objects, and fatal medication errors in frequencies that have not significantly declined over the past decade. According to Marty Makary, MD, MPH, FACS, associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., the blame for these incidents extends well beyond a moment's distraction, to the way that healthcare practitioners have been trained to do business and what they do and don't communicate to each other and their patients. In "How Transparency Can Revolutionize Health Care," he isn't afraid to call it as he sees it.

  • More is less. As a busy doctor, I have watched patients increasingly fed up with a fragmented health care system littered with perverse incentives. It's an industry that does not abide by the same principles of accountability for performance that govern other industries. Instead, our health care system leaves its customers walking in blind. All while simply rewarding doctors for doing more.
  • An altered environment. A hospital is no longer the community pillar I knew growing up, with its altruistic mission guiding its decisions. Hospitals have merged and transformed into giant corporations with little accountability — and they like it that way. Patients are encouraged to think that the healthcare system is a well-oiled machine, competent and all-wise. It's not. It's actually more like the Wild West.
  • What goes wrong. Doctors swear to do no harm. But on the job they soon absorb another unspoken rule: to overlook malpractice in their colleagues. Doctors are generally well intentioned, self-disciplined, and well trained. Most medical-school applicants would detest a career goal to overtreat patients or prescribe expensive interventions. But this is how doctors are socialized. We're subtly taught a bias toward treatment rather than restraint. And while we don't like to admit that the almighty dollar can influence our medical decisions, we all readily concede that it does — for other doctors.
  • The importance of culture. Much of the wide variation in the quality of your medical care can be explained by culture — ?an institution's level of teamwork and its local sense of common mission. Culture is why a nurse at one hospital will, following orders, administer a medicine even though she believes it was ordered incorrectly, while at another hospital, a nurse will insistently page the ordering doctor for clarification.
  • Marty Makary, MD, MPH, FACS
  • What transparency would do. The shocking truth is that some prestigious, large hospitals have four to five times the complication rates of other hospitals in the same city. And within good hospitals, pockets of poorly performing services abound. Transparency of hospital outcomes for common services would reward good performance, identify bad outliers, and drive improvement, harnessing the power of the free market as it should. We do harness the power of the market today, but mainly by erecting billboard ads and improving hospital parking. We can do better than that.
  • The need is now. Discussion of healthcare reform is often hijacked by politicians talking in sound bites who like to oversimplify or misstate the point entirely. We all know the healthcare system is broken, burdening our families, businesses and national debt. It needs common-sense reform. Transparency can empower consumers to make their hospitals accountable and make the practice of medicine more honest.