Medicine’s code of silence
I remember I was a very new and young nurse when I realized most patients haven’t a clue what goes on behind the privacy curtain of medical care in a hospital.
Working in the operating room, I quickly learned who were the best—and the worst—surgeons. The best had skill and good judgement, and I would enthusiastically refer my family and friends, if needed.
And the worst? “Why do these docs still get patient referrals?” I used to wonder. “Why doesn’t the hospital do something? How are patients supposed to know?”
I still ask myself these questions.
Dr. Marty Makary understands. He confesses: “So many times during my residency I wanted to tell patients to run away.”
Disclosure = improvement
In his book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Dr. Makary speaks out against the “closed door culture” that exists in medicine, and highlights his and others’ attempts to push open that door.
A lack of transparency affects all aspects of patient experience: Does the hospital have a good safety record? Does the doctor have a good safety record? Are you getting the most appropriate treatment for your condition? And, not least, how much will it all cost?
Hospitals know. They know which departments have the poorest patient outcomes. They know which doctors have the highest complication rates. They know how much care costs (the chargemaster, remember?).
Unfortunately, thanks to the perverse incentives in our medical system, hospitals actually make more money when patients suffer complications or undergo unnecessary treatments.
Dr. Makary argues that only by being held accountable (like any other business) and required to make “outcomes data” public knowledge—a possible threat to both reputation and financial bottom line—will hospitals be willing to change.
Or some patient dies as a result of poor care and the hospital and staff are pilloried in the press. That usually results in at least short-term improvements.
The science of measuring quality
The difficulty, Dr. Makary admits, is establishing a “scientifically valid way to measure hospital quality and safety from frontline providers.”
Thankfully, he and many others are working on it. They hope to create user-friendly tools that will give patients much more information for choosing a particular hospital other than whether or not the parking is free.
One metric in addition to patient outcomes is teamwork. Initial surveys have shown that increased reports of unit teamwork among staff (physicians, nurses, administration) correlated with fewer infections and complications.
On the flip side, more than half the hospitals surveyed reported poor teamwork. When asked, more than half of those staff said they would not feel comfortable receiving care in their own units.
This book is both frightening and hopeful. Times are changing. A new generation of doctors is not happy with the status quo and wants to be more open with their patients. Dedicated teams of safety specialists are working to create usable tools for patients and demand hospital accountability. Patients, fatigued with high costs, are demanding an answer to the question “What will it cost?”
But change is slow.
Until then, I am inspired to research what tools are currently available to guide patients in the selection of both hospitals and doctors, and learn what is being done at the state and federal level to promote more transparency in health care.
Check back next week and I’ll share what I’ve found.