Hospitals, Doctors and Data: How Transparency Can Help Us, and Them
For anyone considering surgery or a hospital stay, or is curious about the business of healthcare, Marty Makary, MD, has provided an excellent insider account. The author takes the reader through the realities of modern medicine, from medical school and clinical outcome data, to hospital staffing and the culture of the operating room. “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Healthcare” may not turn you into an activist, but it will encourage you to shop around before your next surgical procedure.
To set the stage, Makary tells two stories. The first is about a senior surgeon loved by patients for his bedside manner, but known throughout by hospital staff as dangerously incompetent in the operating room. Despite this knowledge, no action was ever taken and he continued to operate and bring in valuable, profitable business for the organization. The second is about an enterprising New York state official who made hospital patient outcomes public. As expected, once out in the open, hospitals with poor, but now very visible, results began to improve. However, as Makary points out, this New York story is an exception and not the rule. While members of the health industry and government have access to what other industries might consider critical outcome metrics, you, the “patient-customer,” do not.
Each doctor is a detective, searching for clues to patient conditions and coordinating increasingly powerful resources to diagnose and treat. However, this complexity and variability comes at a cost. As the author writes, citing a New England Journal of Medicine report, one quarter of us will be subject to a surgical error. The public, however, will only have stories, “tribal knowledge,” in the language of my former nuclear engineering culture. Without comparable data and results, where can we look to help improve our own decision-making?
Makary knows this is an insider’s game. His test is to ask hospital staff, “Would you have XXX surgery here if you needed it?” Unfortunately, he warns, consumers are unlikely to receive a helpful answer, as the topic can be uncomfortable, even risky, for health professionals. Instead, ask: “How many of XXX surgeries do you perform?” The larger the number, the better. Sometimes critically so.
Complicating the picture is the pace of advancements in health delivery. Some doctors will be ahead of the learning curve on the latest medical procedures and treatments, others behind. In a chapter aptly titled, “How I like to do it,” the author explains how your doctor’s approach can have a big impact on patient outcomes and recovery.
But it isn’t just doctors. Makary writes, “when choosing a hospital beware of clever marketing…[and] don’t be taken in by fancy banners, like ‘center,’ ‘top hospital,’ and ‘best docs.’” The hospitals and doctors themselves often pay for these lists. Instead, volume speaks volumes. When complications arise, as sometimes happen, you want a doctor and support staff that have put in the hours to see all the different ways things can go wrong. As in other areas of life, experience can be a frustratingly efficient teacher.
The story behind the story, perhaps, is one of data transparency helping the industry help itself. If consumers are unable to obtain “product performance” data, then Adam Smith’s “invisible hand” of consumer preferences cannot create a market for good healthcare, one where we collectively reward the providers of good care with more business. Instead, we will show up at hospitals randomly, without regard to product quality. And absent this consumer-provided imperative to improve, hospital staff shortages, administrative errors and avoidable surgical mistakes may remain with the health industry much longer than a new, open environment of data transparency would allow. The good news is I’m sure someone is working on a Fitbit for that.
Thanks for reading. Comments and suggestions for other topics welcome.
Other posts on health include my review of athenahealth co-founder and CEO, Jonathan Bush bestseller, “Where Does It Hurt: An Entreprenuer’s Guide to Fixing Healthcare” here. Also my review of Eric Topol’s bestseller “The Patient Will See You Now: The Future of Medicine is in Your Hands” here. Finally, Steven Brill’s bestseller, “America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System” here.
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