When Dr. Marty Makary was a medical student, staffers at the Boston hospital where he was training had a nickname for one of its most popular surgeons: Dr. Hodad.
"Hodad" is an acronym for "hands of death and destruction": Despite his Ivy League credentials and board certification, the surgeon had an unfortunate tendency to botch operations so badly that patients often suffered life-threatening complications. But he was also one of the surgeons most requested by patients, including celebrities, thanks to his charming bedside manner and their lack of understanding about what caused their post-op problems.
Makary, 42, aims to end the professional code of silence that allows colleagues like Dr. Hodad to thrive. Now a cancer surgeon at Johns Hopkins Hospital in Baltimore, Makary has just published the book Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.
It outlines the extent to which doctors and hospitals suppress objective data about how patients fare in their hands and argues for clear, publicly accessible statistics to help people make the best choices when it comes to treatment. Hospitals and physicians, he argues, should collect "outcomes data" on everything from how many knee-replacement patients walk without a limp to how many prostatectomy patients become incontinent.
Without that, "patients are walking in blind" every time they choose a hospital, Makary said in an interview. With rare exception they have no way of knowing whether they will receive appropriate care or be one of the 100,000 patients killed or 9 million harmed every year in the United States because of medical mistakes.
"There is terrible guilt about keeping quiet, but there are strong social forces against speaking up when you think something doesn't look right: It can get you fired," said Makary. (HealthGrades, a Denver company that develops and markets quality and safety ratings of healthcare providers, rates Makary a "recognized doctor" based on his training and record of no disciplinary actions or malpractice claims.) "You realize as a young doctor that you've walked into an industry with a very dark side."
CLEAR AS MUD
In no U.S. state can patients find out what a surgeon's rate of complications is, how many mistakes a hospital makes, how many avoidable deaths it has or almost anything else about a provider's record of care. Most ratings, from magazines to websites, reflect softer metrics. In the closely watched hospital rankings issued by U.S. News & World report, "reputation," or what specialists think of a hospital, counts 32.5 percent toward overall scores. Patient volume, number of nurses, use of advanced technologies and 30-day mortality rates also count.
The federal government collects and makes public some measures, such as hospitals' rates of complications and mortality after certain procedures, on the Hospital Compare website. About half the states require hospitals to make public what percentage of patients develop infections. While that's better than nothing, says Dr. John Santa of Consumers Union, publisher of Consumer Reports, providers have largely succeeded in hiding their records. "Despite the best efforts, if hospitals don't have to report something they don't," said Santa. For example, a regular survey by Johns Hopkins asks staffers at 60 hospitals about safety and teamwork. Studies show that hospitals scoring high on the surveys have fewer surgical complications and better patient outcomes. But hospitals participate "under the condition that the results remain top secret," said Makary.
Specialist groups also gather data, including the Society of Thoracic Surgeons, which tracks national heart-surgery outcomes. Only one-third of hospitals have agreed to post their results on the society's website.