About book Unaccountable: What Hospitals Won't Tell You And How Transparency Can Revolutionize Health Care (2012)
By far the best thing I have read about the American health care system. It certainly made me think differently about the system, and indeed about my own health care. Dr. Makary's real-life experiences help buttress his logical and well-supported observations. His call for transparency has real promise both for improving the quality and delivery of health care and for corralling cost growth. However, there are powerful entrenched forces that stand in the way, and it's unclear how this reform can be realized. I met Dr. Makary at the HIMSS 2014 Conference in Orlando last week where he spoke on this topic (and held a book signing). His speaking is just as engaging and motivating as his writing. Overall, transparency, I agree, is a good thing and will go a long way toward improving patient safety. One of the things to look out for: gaming the system. Dr. Makary makes the point in the last chapter (p. 213) that "Doctors understand the science and have developed non biased methodologies for tracking quality, and a younger generation is already expressing a distaste for the old way of doing things." Unfortunately, there are "bad actors" in every organization, health care systems not excluded. In fact, this book is chock full of examples of them. These "bad actors" have that same understanding, and non-patient-safety-related motives by which to attempt to bias results. Safeguards will have to be built in to detect such tampering.Dr. Makary used an example in his talk that is not in this book that I think wonderfully sums up the value of open feedback from customers (patients): TripAdvisor. He related a recent conference he attended in Azerbaijan (I think) where the quality of the hotels was exceptional. He was informed by staff there that it was always so good. TripAdvisor.com, and more specifically the candid (if sometimes rude and snarky) customer reviews (like this one? I hope not...) really lit a fire under the management of the hotels in Azerbaijan, and they really upped their game. Suddenly, the managers and staff were being held accountable, even after the guest was gone, and that unhappy guest had the ability to negatively affect the opinions of potential future customers. I know I personally used TripAdvisor.com to help plan my upcoming trip to Ireland, and I'm definitely looking at what folks who have experienced the services in the places we want to eat, play, and sleep, and it's definitely affecting my decisions. I seen no reason why this model shouldn't or couldn't extend to healthcare, and Dr. Makary makes a good case in this book on how and why it would work.
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Now i'm even more troubled by the US health care system. Well researched and thorough.
—Fitz
