'Unaccountable' What Hospitals Won't Tell You

My husband works in the health insurance industry helping companies and individuals reduce the cost of their health care.  His money-saving views on medicine create a great balance for me, a nurse practitioner immersed in the medical system and paid based on productivity.  To provide me some insight into his points of view, he has recommended a few books for me to read.  Recently, I completed 'Unaccountable' What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care by Dr. Marty Makary.

The first thing that struck me about Dr. Makary's book was that, well, it is written by a doctor.  Dr. Makary's whistle-blowing publication promises to give readers insight from a practicing physician as to what actually goes on inside hospital walls, within the minds of medical providers and hospital administrators.  Even with my intimate knowledge of the health care system, I found his insights quite enlightening.

Makary begins his book by describing his medical residency, in particular one medical provider nicknamed "HODAD" by residents, an acronym for "hands of death and destruction".  This surgeon's moniker was well deserved based on his alarming rate of botched surgeries.  HODAD's patients however were unaware of his tendency for post-op complications.

'Unaccountable' explores the disturbingly high rates of preventable medical complications in America's hospitals.  25 percent of all hospitalized individuals will experience a preventable medical error.  Hospital administration however has little incentive to fire medical providers, particularly surgeons, with high rates of complications.  A hospital stands to make $10,000 in additional revenue for each surgical complication- after all, surgeons are paid to fix their own mistakes.

Makary calls into question just why patients are unable to find statistics based on the safety of their hospitals and medical providers.  This information is kept largely unpublished and unavailable to the public.  Makary advocates for more transparency in medicine to protect patients and reward capable providers.  Rather than publish sound safety and quality data, hospitals tend to pay-off companies and organizations to give them a "No. 1 Ranking" for various treatments and diagnoses.

'Unaccountable' proved very eye-opening for me as a nurse practitioner.  It lead me to question my practices and those of providers with whom I work.  It exposed me particularly to the unnecessary complications of many surgeries and to understand the frustration of my patients who frequently dislike their specialists and surgeons.

This book is a must read for nurse practitioners.  It will challenge your views of the system within which you work and help you relate to your patients as well as other providers.

Enjoy reading?  You might also like Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer By Shannon Brownlee.


I gotta say...it doesn't really matter if the data is readily available because patients do not select their hospitals or providers based on rankings that are available. For example, they do not review healthcare quality data that is available on the web and published by CMS. One hospital I worked with queried its patients about how they selected a hospital. Most common answer: my doctor is here. Second most common answer: geography. Patients simply do not believe that quality matters in healthcare. They believe accidents and bad outcomes happen to OTHER people.