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A Call for Transparency in Health Care By Gerald Rogan, MD


he Shah of Iran needed a splenectomy for his blood cancer. His team engaged the man many considered the “best surgeon in the U.S.,” the renowned Dr. Michael DeBakey. Even though he was not an expert with splenectomies, DeBakey operated. He failed to place a drain into the splenic bed. Pancreatic fluid leaked out, leading to infection and sepsis. In a few months, the Shah was dead. The death of the Shah is one of several similar stories Marty Makary, MD, tells in his 2012 book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. Makary includes his own story of how his disillusionment with medical education drove him to drop out of medical school to study public health, then return to become a surgeon with an emphasis on quality improvement. A nationally known expert, Makary has extensive experience with medical practice and government oversight. His book explains how medical outcomes are measured and reported by hospitals. Makary offers practical solutions physicians can champion at their institutions to improve measurable quality of outcomes. Unaccountable can serve as a guide for patients who want to learn how to ensure they receive quality care as well as for hospital board members who want to serve their communities through greater accountability of

hospital-based care. For example, would you agree to have your failed hip implant replaced by a prominent surgeon (e.g., a chief of staff) who has never performed one, or would you prefer a surgeon with special post-graduate training? Why would your surgeon offer to perform such a procedure when better-trained surgeons are available? Does your hospital allow surgeons to perform low-volume operations when a sister hospital nearby performs 10 times more every year? Does your institution measure its post-op complication rate and share its results online for patients to evaluate? What questions can you expect your patients to ask in order to know whether the quality of care your institution provides is acceptable? My copy of Unaccountable, signed by Makary himself, was given to me by a colleague who worked with Makary and who now works at Public Citizen in Washington, D.C. Makary’s book details practical measures which may eventually improve outcomes through the use of data that compels preventive and corrective action, rather than blame and shame. It is the best book I have read on the subject. Had the Shah of Iran or his medical advisor read or followed the advice in this book, the Shah would have hired a surgeon who was an expert in splenectomy, not the “superdoctor” who had made his name as a cardiovascular surgeon. Leave your ego at the door when you read this enlightening book. Advertisement

Doctor-Mentors Needed Are you a physician willing to donate a few hours of your time to mentor eager new medical students? The Willow Clinic, an affiliated UC Davis School of Medicine program, needs doctors like you. We’re recruiting friendly people with a desire


Sierra Sacramento Valley Medicine

to teach the next generation of physicians and to help the community. The clinic serves Sacramento’s homeless and is open every Saturday from 9 a.m. to 1 p.m. Volunteer physicians are welcome on a one-time only or rotating basis. For further information, contact:

Profile for Sierra Sacramento Valley Medical Society

2019-Jul/Aug - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...

2019-Jul/Aug - SSV Medicine  

Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...