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Taming the ‘Wild West’

I recently devoured a fascinating book that is very disturbing and yet, potentially uplifting. I sound a bit schizophrenic, don’t you think?

Allow me to explain.

The book, “Unaccountable“, is written by Dr. Martin Makary, a highly-accomplished laparoscopic surgeon at the Johns Hopkins Hospital and an international expert on patient safety. Makary is an advocate for transparency in medicine and developed The Surgical Safety Checklist which was popularized in the Atul Gawande’s best-selling book, The Checklist Manifesto. His accomplishments are extremely impressive…and so is his book, published in September of this year.

The book is full of disturbing scenarios of unintended consequences patients face while interfacing with a “fragmented health care system littered with perverse incentives.” As Makary states, our healthcare ‘system’ is “an industry that does not abide by the same principles of accountability for performance that govern other industries.” One statistic says it all to me: Medical mistakes kill enough people each week to fill four jumbo jets – yet we do not read about this on the front pages of our newspapers. FYI – there are over 400 seats in one standard Boeing 747 jumbo.

Quite disturbing.

Makary shares intimate and revealing insider information – more meaningful due to the credibility of the messenger: “Patients are encouraged to think that the health care system is a well-oiled machine, competent and all-wise. It’s not. It’s actually more like the Wild West.” The Wild West?

An inexcusable by-product that comes from our perverse health care ‘system’ was published in the prestigious New England Journal of Medicine in 2010:

As many as 25 percent of all patients are harmed by medical mistakes. What’s even less known to the public is that over the past ten years, error rates have not come down, despite numerous efforts to make medical care safer. Medical mistakes are but one costly example of how health care’s closed-door culture feeds complacency about its problems.” As Makary points out, if medical errors were a disease, they would be the sixth leading cause of death in the U.S. – just behind accidents.

No wonder our health insurance rates continue to consistently outpace inflation – we pay for medical mistakes that are extremely expensive…both in dollars and, most unfortunately, in lives. Reforming health care should really be about reforming the ACCOUNTABILITY of how health care is delivered in this country.

Now, for the uplifting portion of his book – Makary proposes that our healthcare ‘system’ can be fixed by implementing common sense solutions to empower patients with useful information when seeking appropriate medical care. Makary is passionate about the need for hospitals to make their outcomes available on the Internet so that patients can become informed and engaged “consumers.”

Hospital reporting measures would include the following:

  1. Bouncebacks: Documenting the percentage of hospitalized patients who are re-admitted to a hospital within 90 days.
  2. Complication Rates: Documenting any unexpected, adverse event that develops during or after a medical treatment or procedure.
  3. Never-Events: Documenting things that should never happen in a hospital.
  4. Safety-Culture Scores: Survey hospital workers who believe (or don’t believe) they work in safe hospitals. This reporting tool can be critical to the general public.
  5. Hospital Volumes: Number of patients with a particular type of medical condition who are treated and the frequency of each type of surgery performed annually by each hospital.
  6. Transparent Records, Open Notes, and Video Recording: Encourage hospitals to implement initiatives that allow patients to have access to written and video records following surgical procedures.

My great hope is that healthcare in this country will transition from the Wild West to the New Frontier that we all deserve – having safe, affordable and full accountability that will provide for quality and efficiency.

It cannot happen fast enough – for all of us.

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