Book Review: Unaccountable
Author: Marty Makary, M.D., M.P.H.
Publisher: Bloomsbury Press
Book Publication: 2012
Most people trust, respect and defer to doctors. After all, MDs are highly educated and have taken the oath: “First, do no harm.” But suppose a respected insider from one of the world’s most prestigious training institutions warned you that modern medicine is dangerous? Suppose he told you stories about the harm he witnessed being perpetrated upon unsuspecting patients like you and me? And, suppose his colleagues believed that this was a story worth telling in an effort to increase transparency and promote accountability, with the hope of restoring the credibility of a broken health care system?
In his timely book, Unaccountable, Johns Hopkins surgeon and associate professor, Marty Makary, M.D., M.P.H. does just that. He addresses the dangers and lack of transparency of modern medicine and empowers readers with the knowledge to become informed consumers when choosing who to look after their health. Although Makary writes about American hospitals, we in Canada could also learn from his guidance.
It was via Dr. Peter Attia, a Torontonian and Queen’s University engineering graduate, that I came across this book. Attia, an Olympic level athlete, experienced a bout of debilitating back pain while studying to become an oncology surgeon at Stanford University. An MRI showed he had a herniated disk and a fragment sitting on a nerve, causing shooting pains down his left leg. He was operated on by a supposedly talented and reputable neurosurgeon. But when he woke up from surgery, not only were his back and left leg still painful, but he could hardly move his right foot, which had been fine prior to the operation. It turned out that the wrong side of his back had been operated on.
This is but one of the many shocking stories Makary tells in Unaccountable. He cites a study that reported that one in four patients are harmed by medical error and another that found doctors operate on the wrong person or the wrong body part as often as 40 times per week.
Makary is weary of a compensation model widely referred to as “eat what you kill” versus flat salary for doctors, and the disconnect between hospital administration and medical professionals who have promoted unnecessary and often dangerous highly profitable medical procedures. He cautions about the hazing of interns, who often work 30-hour shifts, caring for countless patients, living in fear of being ridiculed for asking for help.
While at Harvard, as an intern, Makary worked for a man secretly referred to as ‘Dr. Hodad’, a charismatic and popular surgeon, H-O-D-A-D standing for “hands of death and destruction.” Makary, like other support staff in hospitals, learned to keep the code of silence even after witnessing atrocious care from veteran doctors while the patient remained completely unaware. Whistleblowers were bad-mouthed, ousted or discredited in retaliation.
But, one year, having had enough, Makary bailed on medical school. He switched to the Harvard School of Public Health. While enjoying the study of how to prevent disease, he soon realized that he preferred to care directly for patients. He returned to medical school, determined to practice with the utmost accountability and integrity.
So there is hope and it begins with Makary’s courage to help create awareness. He has proactively led the way in promoting patient safety and developing ways of measuring health care. He has helped to create life-saving surgical checklists. He encourages the use of videos for procedures undertaken in hospitals, which help to increase compliance with medical guidelines. He is a pioneer. Because of doctors like Makary, and a new generation of students demanding honesty, accountability, and transparency, some hospitals are now rated for safety. Metrics for performance are forthcoming. Adverse event reports will be mandated. But we the consumers must not be complacent. We must be wise. We have to do our research and shop around for the best care available. Let us start by reading Unaccountable. Our health and the health of our health care system depend on it.