Makary: Americans victims of medical errors, waste
The Johns Hopkins surgeon, whose new book “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care,” details financial and human cost of wasteful practices and dreadful errors that plague American medicine spoke to Human Events.
“We are seeing a revolution in health care, and I don’t see myself as the leader of that revolution, I see myself as someone, who is observing it, describing it in the book,” said Dr. Martin A. Makary, who in addition to his faculty position at the Baltimore school, serves on posts at the World Health Organization and as commentator on CNN.
Makary, who specializes in minimally-invasive surgery to remove tumors, said “Both the book and the Institute of Medicine report have really ignited a national conversation about a subject that many studies show there is an epidemic in U.S. health care,” he said.
“What happened was that the book came out within weeks of the Institute of Medicine’s report that suggested that prior estimates of the number of people killed from medical mistakes far understated the problem,” he said.
“It also estimated that 30 percent of all the things done in health care may be unnecessary,” he said.
“Those are tough estimates to swallow for anyone, especially myself—someone who is very proud of his profession and someone who loves being a doctor, loves doing complex surgery—it is a shot across the bow,” said Makary, who contributed to Dr. Atul Gawnde’s book “The Checklist Manifesto.”
“I think that part of the problem has been, we have not really had a culture, where we can talk open and honestly about the raw problems in health care: the problems many of us have witnessed or know about, even in our own area until recently,” he said.
The solution to the problem is transparency, the surgeon said.
By taking advantage of electronic record keeping and making non-patient specific data publically available, people could make informed decisions—as they do for other purchases, Makary said.
“Things that Mitt Romney talks about that people don’t appreciate, like he has said that he wants to separate the insurance from the employer, so you don’t have to worry about your insurance when you jump jobs—that is a very popular idea and the AMA has supported it, long before Mitt Romney was talking about it,” he said.
“Right now, we have a free market that is totally dysfunctional,” he said.
“I talk to patients, and I ask them: ‘Why did you come to this hospital?’” he said. “My patients are the consumers, and hospitals are out for their business, and patients say things like: ‘The parking is easiest here,’” he said. “They need to make decisions based on the performance of the hospital.”
In the effort to improve the quality of the conversation, physicians are taking the lead, he said.
“It’s been, actually, the doctors’ groups, which have been swimming against the current to raise awareness and measure the problems,” said the Liverpool surgeon, who is married to Fox News political analyst Kirsten Powers.
“We’ve now got one of the largest doctors’ groups in the United States, the American Board of Internal Medicine, publishing a list of things they believe are over done in their own specialty,” he said.
“These are common doctors saying that common things done in their own field are way-overdone,” he said. “They are telling patients, look at this list, and if you are going to have something done on this list, think twice, it may not be necessary; talk to your doctor about it first.”
“To say that a third of what we do is not even necessary is quite a statement in an industry that values science, validity and precision,” he said.
“What other industry misses the mark that often?” said the Baltimore-raised doctor.
“We have to step back and look at the global level at the whole system and say: ‘Look, 15 percent of stents are unnecessary, 25 percent of pace makers are unnecessary, we got neuro-surgeons saying implantable devices are unnecessary 20 to 30 percent of the time,” he said.
“Pap smears are overdone, hysterectomies, too,” he said.
“It’s a real problem, and families and businesses are really suffering,” he said.
“You’ve got these individual pockets of medicine, and listen to the specialists talk about it being like the Old West in their own field,” he said. “In some fields, it has been much more dramatic than others like my own, cancer.”
By its very nature, cancer treatment is not prone to waste, he said.
“In cancer surgery there is much less over-treatment because people come in and they want the cancer out,” he said. “They walk in our office and we take it out,” he said.
Patients are much more focused and the threat is too serious to allow for the wrong treatment, he said.
“It’s not like back surgery or heart stents, where there is a lot of border line stuff,” he said.
“If we listen to the doctors in aggregate and put all the studies together, we have a real problem in health care and if we’re going to talk about health care costs in all sorts of debates as we do in presidential debates and all kinds of national forums,” he said.
“I mean, we spend a ton of money on the number one cause of death in the U.S., trying to prevent it, research it and treat it, and that is heart disease and a ton of money on number two, cancer,” he said.
“The internalists’ study suggests, based on solid scientific evidence, top medical journals and respected institutions, that the number three cause of death in the United States and medical mistakes and preventable infections—and we don’t even talk about it,” he said.
“If we just look at the HHS Office of the Inspector General’s report saying 180,000 Medicare beneficiaries, alone, die each year from preventable mistakes,” he said.
Using the estimates from the Atlanta-based Center for Disease Control, not even counting infections, preventable mistakes would be the third most common cause of death in the country, he said.
Markaray, who is rumored to be on the short list of candidates to become the next Surgeon General, said he is not political when it comes to health care reform.
Both Romney and Obama have good ideas, but neither one is listening to the other, he said.
“They are more interested in making the other person look bad than they are in listening–sometimes,” said Makary, whose father worked as a hematologist.
Makary does not use the term death panels, and he said he sees the need for appointed boards empowered to rein in costs.
“The problem is that those decisions are being micro-managed by members of Congress, who are in bed with giant stakeholders in the industries,” he said.
“We’ve got things in health care, where we know—and everyone agrees—there are tons of abuse, look at durable medical goods, motorized wheel chairs, home oxygen, we know there is massive overuse of these things,” he said.
“We could apply standards, but the industry is too strong,” he said.
“All sorts of former directors of Medicare have talked about this problem—after they’ve had the job,” he said. “The industry is too tough.”
“Then on the flip side, if you give all of the power to a small, select group of people that has its own dangers,” he said.
“People say they are not elected, but that is actually one of the advantages,” he said.
“It is not a perfect system, but it is a way to make sure they are independent in the same way, we don’t elect Supreme Court justices,” he said.
Yet, the doctor said that he acknowledges that the justices are never truly independent.