Unaccountable:

What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care

By Marty Makary

I was afraid to read this book. I put it off for a long time while I struggled with myself. On the one hand, I wanted to be informed. On the other, I was afraid that it would scare me away from ever going to the hospital ever again. As it turned out, that's not the case *wipes nervous sweat from brow*

Yes, there are plenty of horror stories in here. There are also stories of fantastic surgeons who have had phenomenal success. The problem is that patients aren't being given access to the information we need to make informed decisions about which hospital to go to or which surgeon to have perform our surgery. The most frustrating part about it is that hospitals have the information, they just refuse to let us see it. They keep it under lock and key. It's their most closely guarded secret. Thanks to the internet and digital systems hospitals can now track their 90-day readmission rate, as well as the number of deaths and complications from surgery.

Here's the really frightening thing: hospitals make money off of complications. The longer you have to stay in the hospital, the more money they make. So their motivation to discipline or get rid of surgeons with high complication rates doesn't really exist (other than, you know, actually being a decent human being, but I guess that gets sidelined when money is involved). So they don't do anything about it. They just keep raking in the big bucks. For obvious reasons, this is a huge burden on the individual patients, employers, and the government.

Makary is convinced that this is responsible for much of our current economic crisis. While most of us are getting worked up over government subsidized health care, Makary insists that basic accountability would lower complications, thereby significantly lowering health care costs. Along with this idea, Makary talks about the way hospitals will buy up the newest technology simply because it's cool. He describes one machine that hospitals have been buying up in droves that allows surgeons to perform remotely. However, while there are certain benefits to having robotic arms, rather than human arms, open up a person, there are also drawbacks. At least a couple people had horror stories of the machine getting in the way of the doctors performing CPR when a patient coded on the table. Despite these risks, and its limited benefits, Makary describes surgeons drooling over themselves at the prospect of using this new machine. He admits that, in the future, it might very well prove beneficial but, at this point, it's hardly a reason for hospitals to spend the millions on it that they are currently lining up to do.

As infuriating as it is that hospitals refuse to release basic information such as their complication and readmission rates, Makary provides the reader with hope. Obviously, you can always get a second opinion. You can ask the right questions, such as "How many surgeries of this type do you perform annually? And, as always, there's the handy dandy internet! No, not everything you see on the internet is true, but you can get first-hand accounts of people's experiences. One patient Makary mentioned used the internet to research hysterectomies. When her doctor refused to do one laparoscopically, she went to one who would because she had seen that other doctors were doing it and having success with less recovery time.