Skip to main content

Is your hospital hurting you?

By Marty Makary, Special to CNN
updated 4:03 PM EST, Wed January 2, 2013
Our health care system should try to reduce the number of unnecessary medical procedures, says Marty Makary.
Our health care system should try to reduce the number of unnecessary medical procedures, says Marty Makary.
STORY HIGHLIGHTS
  • Marty Makary: Doctors who talk about fraudulent medical care risk losing job
  • Makary: Doctors increasingly feel disconnected with policymakers and hospitals
  • He says some hospitals are becoming mega-corporations with little accountability
  • Makary: Doctor should be encouraged to voice safety concerns to their managers

Editor's note: Dr. Marty Makary, a surgeon at Johns Hopkins hospital, is author of "Unaccountable."

(CNN) -- Last year, Dr. Kiran Sagar, a cardiologist in Wisconsin, was fired two months after presenting strong data showing that cardiologists in the hospital she worked at misread a substantial number of heart tests. Similarly, a nurse from Columbia Hospital Corp. of America (HCA) was let go after complaining that a doctor was performing unnecessary cardiac procedures, even after an internal investigation found the nurse's claim to be substantiated. And a few weeks ago, the CBS News program "60 Minutes" reported on ER doctors fired for not meeting quotas on the percentage of patients they admitted to the hospital.

These recent patterns of firings send yet another strong message to every doctor and nurse who has ever considered speaking up about dangerous and fraudulent medical care: Speak up and risk destroying your career.

The culture of health care needs to change. Medical mistakes cause too many needless harm or deaths, yet few people see the problem in this context because we rarely have an open and honest conversation about the quality of health care in America. When we do, it is often behind closed doors. This is a challenge that a new generation of doctors is working to change through initiatives ranging from more transparent bedside care to public reporting of hospital performance.

Marty Makary
Marty Makary

Doctors and nurses increasingly feel disconnected from policymakers and even their own hospitals, some of which have transformed into giant corporations. Despite concerns from the Federal Trade Commission that costs will go up for consumers, hospital mega-mergers are on the rise.

Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



This past year saw a large number of hospital mergers and acquisitions in health care. While some hospital executives have commendably used a hospital chain's large size to standardize best practices, others have fallen into the age-old management trap of detaching themselves from the front lines and becoming dangerously out of touch with their own staff.

I talk to doctors and nurses around the country every week. One trend that seems clear is that more doctors and nurses are feeling frustrated. A recent national study by Mayo Clinic researchers shows that doctor burnout rate is now up to a staggering 46%.

A new phenomenon, quite different from when my father practiced medicine, is that doctors and nurses now say they feel like they are tenants working for their landlord: the hospital management. Often, doctors and nurses know how to make care better and safer but feel stripped of the power to make necessary changes.

This worker-management disconnect (even antagonism) in any industry is dangerous. In medicine this workplace atmosphere, complicated by perverse economic incentives and weak systems of accountability, contributes to a hospital culture marked by a lack of a sense of communal ownership in the overall delivery of care. What results is a poorer quality of care, more overtreatment, more fraud, more medical mistakes, and more patients falling through the cracks.

According to a 2009 CBS-New York Times poll, 77% of Americans say they are satisfied with the quality of their health care. But what makes people think the health care they're receiving is good? Very little. A Harvard study published in the New England Journal of Medicine reported an alarming fact: 18% of patients were actually harmed by medical care. The Congressional Budget Office estimates that up to 30% of health care procedures, tests and other services do not improve health outcomes.

For instance, if you had a medical condition, would you go to a hospital that has performed more than 1,000 unnecessary procedures? Probably not.

As much as one-third of all health care expenditures may be going to waste, fraud and unnecessary medical care. This problem is high on the agenda for the American Board of Internal Medicine. Other physician groups have joined the "Choosing Wisely" Campaign to address unnecessary care in American medicine. The Institute of Medicine is calling attention to the problem, and many medical researchers are speaking openly about it. But more needs to be done.

Rather than reinforce a closed-door culture in American medicine, hospitals should use their new large size to encourage external and independent peer reviews and create a culture of transparency.

Patients should be encouraged to keep a copy of their medical records, not inconvenienced with burdensome processes and extra charges to obtain them. A hospital's front-line health care workers are their work engine, and these people should be encouraged to voice their safety concerns to their managers.

Mega-hospitals need to stay true to their mission and not fall into the large corporate pitfalls that can erode the standing of any business. A workplace culture that punishes those who speak up about problems by depriving them of their career livelihood is part of the problem itself.

As a surgeon, I sometimes see patients after they have blindly walked into the hands of dangerous, expensive and avoidable care. If we are serious about improving health care quality and lowering costs, we need to address the issue of accountability. Our hospitals must be more accountable to patients and doctors.

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Marty Makary.

ADVERTISEMENT
Part of complete coverage on
updated 8:59 AM EDT, Mon September 22, 2014
You could be forgiven for thinking no one cares -- or even should care, right now -- about climate change, writes CNN's John Sutter. But you'd be mistaken.
updated 5:32 PM EDT, Sun September 21, 2014
David Gergen says the White House's war against ISIS is getting off to a rough start and needs to be set right
updated 9:00 AM EDT, Mon September 22, 2014
John Sutter boarded a leaky oyster boat in Connecticut with a captain who can't swim as he set off to get world leaders to act on climate change
updated 3:17 PM EDT, Mon September 22, 2014
Ruben Navarrette says making rude use of the Mexican flag on Mexican independence day in a concert in Mexico was extremely tasteless, but not an international incident.
updated 9:59 AM EDT, Mon September 22, 2014
Michael Dunn is going to stand trial again after a jury was unable to reach a verdict; Mark O'Mara hopes for a fair trial.
updated 7:15 PM EDT, Mon September 22, 2014
Is ballet dying? CNN spoke with Isabella Boylston, a principal dancer at the American Ballet Theatre, about the future of the art form.
updated 5:47 PM EDT, Fri September 19, 2014
Sally Kohn says it's time we take climate change as seriously as we do warfare in the Middle East
updated 3:27 PM EDT, Mon September 22, 2014
Laurence Steinberg says the high obesity rate among young children is worrisome for a host of reasons
updated 9:02 AM EDT, Fri September 19, 2014
Dean Obeidallah says an Oklahoma state representative's hateful remarks were rightfully condemned by religious leaders..
updated 3:22 PM EDT, Fri September 19, 2014
No matter how much planning has gone into U.S. military plans to counter the Islamic State in Iraq and Syria, the Arab public isn't convinced that anything will change, says Geneive Abdo
updated 11:44 AM EDT, Fri September 19, 2014
President Obama's strategy for destroying ISIS seems to depend on a volley of air strikes. That won't be enough, says Haider Mullick.
updated 9:03 AM EDT, Fri September 19, 2014
Paul Begala says Hillary Clinton has plenty of good reasons not to jump into the 2016 race now
updated 11:01 AM EDT, Fri September 19, 2014
Scotland decided to trust its 16-year-olds to vote in the biggest question in its history. Americans, in contrast, don't even trust theirs to help pick the county sheriff. Who's right?
updated 9:57 PM EDT, Thu September 18, 2014
Ruben Navarrette says spanking is an acceptable form of disciplining a child, as long as you follow the rules.
updated 11:47 AM EDT, Fri September 19, 2014
Frida Ghitis says the foiled Australian plot shows ISIS is working diligently to taunt the U.S. and its allies.
updated 3:58 PM EDT, Fri September 19, 2014
Young U.S. voters by and large just do not see the midterm elections offering legitimate choices because, in their eyes, Congress has proven to be largely ineffectual, and worse uncaring, argues John Della Volpe
updated 9:58 PM EDT, Thu September 18, 2014
Steven Holmes says spanking, a practice that is ingrained in our culture, accomplishes nothing positive and causes harm.
updated 2:31 PM EDT, Thu September 18, 2014
Sally Kohn says America tried "Cowboy Adventurism" as a foreign policy strategy; it failed. So why try it again?
updated 10:27 AM EDT, Thu September 18, 2014
Van Jones says the video of John Crawford III, who was shot by a police officer in Walmart, should be released.
updated 10:48 AM EDT, Thu September 18, 2014
NASA will need to embrace new entrants and promote a lot more competition in future, argues Newt Gingrich.
updated 7:15 PM EDT, Tue September 16, 2014
If U.S. wants to see real change in Iraq and Syria, it will have to empower moderate forces, says Fouad Siniora.
updated 8:34 PM EDT, Wed September 17, 2014
Mark O'Mara says there are basic rules to follow when interacting with law enforcement: respect their authority.
updated 9:05 AM EDT, Tue September 16, 2014
LZ Granderson says Congress has rebuked the NFL on domestic violence issue, but why not a federal judge?
updated 7:49 AM EDT, Tue September 16, 2014
Mel Robbins says the only person you can legally hit in the United States is a child. That's wrong.
updated 1:23 PM EDT, Mon September 15, 2014
Eric Liu says seeing many friends fight so hard for same-sex marriage rights made him appreciate marriage.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT