As a private pilot who has spent the better part of my professional life navigating the labyrinthine health care industry, I am intrigued by Dr. Marty Makary’s recent comparison of aviation and health care in the Wall Street Journal, adapted from his book “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care”:
When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.
The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.
Dr. Makary continues:
As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?
I’m not sure I have an answer to that question (maybe our present prison or educational systems would be in the running?) but what really intrigues me is the fact that this industry, warts and all, remains one of the most profitable and prosperous in the country. It’s astonishing, really.
Dr. Makay goes on to make a number of excellent suggestions as to how to improve the situation. He focuses on increasing accountability through a variety of means, including:
- creating online dashboards that include such metrics like its rates for reinfection, readmission, surgical complications and “near event” errors (like leaving a sponge or surgical tool inside a patient)
- generating safety culture scores to help shed light on the 98,000 annual deaths from medical errors in the U.S.
- installing cameras to improve compliance with best practices and established procedures and to allow for reviews and to determine retraining needs when serious mistakes are made (like the “black box” in airplanes)
- using an “open notes” system where patients and other doctors are given real-time access to their doctors’ notes
- moving away from gagging to a system of transparency to allow free market forces to work in medicine, with the aim of improving accountability and restoring patients’ choice in a system that has grown to be secretive if not arrogant
My own impression is that what we deliver is as important as how we deliver it. We need to re-prioritize our treatment protocols. The entire system is biased toward eleventh-hour, expensive and typically highly invasive interventions which are more often than not laden with unintended and unhelpful side-effects. The system we have competently deals with acute situations, medical emergencies and the like, but demonstrates an impressive incompetence when confronting the more prevalent, complex and burdensome spectrum of chronic diseases.
I have the utmost confidence that we can revolutionize health care. We can revitalize medicine in a way that reignites the passion of its practitioners and restores the confidence of its patients.
Gregory Hake 
This is something that has been important to me for a long time. Burying things under the carpet, whether in industry or in personal life, leads to nothing but heartache and disorder. The medical industry, and not just the hospital but the entire industry, makes a great show of being a heavily regulated industry that follows its best practices. However I think that anyone that looks honestly can see that this is not always the case. There are many other interests controlling things that do not necessarily have the best interests of the patient at heart. However, I am convinced that it can be changed.
LikeLike
Great post. I will share it on my website.
LikeLike
While asking for these metrics in this secretive industry in the WSJ is a start, we can assist with the changes by how we relate to this system. When faced with a hospital stay become involved in the decision making process. Take the responsibility to understand your options and be willing to make the tough decisions. Don’t expect the system will work if you are not fully participating as a responsible patient or family member. My experience with it is those involved are VERY aware of its shortcomings and most are relieved to work with informed, or concerned to become informed, patients. Ask questions respectfully and expect respectful treatment. If that doesn’t happen ask for different care givers, change doctors and find those hospitals willing to supply the care. They are all commodities and only become dictators if we give them that stature. Hospital care is so competitive we do vote with our dollars there!
LikeLike
Interesting article. From my perspective in the healthcare industry, I see with optimism the changes that are already happening, albeit quietly and unassuming at this point. The new generation of healthcare practitioners are growing up in quite a different culture – a far more transparent one – and as such, are in the process of a systemic adaptation in their own consciousness, one which is certainly shaping the industry itself, urging the industry to evolve. Articles like this one you mention is one of many examples that herald this change. Medicine in its soul is a sacred vocation and that spirit can never die, the spirit of health, healing and servitude, for it lives in the soul of man. It may get marred and glossed over at times due to this little thing called ignorance, but it won’t ever go away.
What determines the rate of progress at this point I feel depends on how much of an open, non-combative mind each one of us can keep. Tensions are high for the system is stressed to almost the breaking point, but people by and large in the field of medicine still want to do the right thing and many practitioners are beginning to question the system’s built in assumptions – always a positive thing that yields a revitalizing influence.
I hope that we all maintain our faith throughout this process of change and resist becoming too cynical, as we just need to maintain focus on the issues that are up for debate and concentrate our collaborative efforts to bring about these changes. The attitude we take is so vital, for an inclusive, warm tone greatly helps to speak this message that inspires people to work together, not separating them. We cannot afford polarizing, judgemental and inciting attacks any longer if we are to make it through this next phase.
LikeLike
Enlightening!!
LikeLike
Wow, astonishing statistics. I love Dr. Makay’s suggestions and hope that some of these changes can be made in our healthcare system!
LikeLike