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 12:41 PM EDT, Wed April 23, 2014
Robert Hickey says most new housing development is high-end, catering to high-earners.
updated 9:17 AM EDT, Wed April 23, 2014
Alexander Motyl says as Russian President Putin snarled at Ukraine, his foreign minister was signing a conciliatory accord with the West. Whatever the game, the accord is a major stand down by Russia
updated 8:29 AM EDT, Wed April 23, 2014
Les Abend says at every turn, the stowaway teen defied the odds of discovery and survival. What pilot would have thought to look for a person in the wheel well?
updated 6:47 PM EDT, Tue April 22, 2014
Q & A with artist Rachel Sussman on her new book of photographs, "The Oldest Living Things in the World."
updated 3:58 PM EDT, Tue April 22, 2014
Martin Blaser says the overuse of antibiotics threatens to deplete our bodies of "good" microbes, leaving us vulnerable to an unstoppable plague--an "antibiotic winter"
updated 1:37 PM EDT, Tue April 22, 2014
John Sutter asks: Is it possible to eat meat in modern-day America and consider yourself an environmentalist without being a hypocrite?
updated 11:38 AM EDT, Tue April 22, 2014
Sally Kohn notes that Meb Keflezighi rightly was called an American after he won the Boston Marathon, but his status in the U.S. once was questioned
updated 8:56 AM EDT, Tue April 22, 2014
Denis Hayes and Scott Denman say on this Earth Day, the dawn of the Solar Age is already upon us and the Atomic Age of nuclear power is in decline
updated 4:36 PM EDT, Mon April 21, 2014
Retired Coast Guard officer James Loy says a ship captain bears huge responsibility.
updated 1:08 PM EDT, Mon April 21, 2014
Peter Bergen says the latest strikes are part of an aggressive U.S. effort to target militants, including a bomb maker
updated 9:45 AM EDT, Mon April 21, 2014
Cynthia Lummis and Peter Welch say 16 agencies carry out national intelligence, and their budgets are top secret. We need to know how they are spending our money.
updated 8:35 AM EDT, Mon April 21, 2014
Julian Zelizer says President Obama knows more than anyone that he has much at stake in the midterm elections.
updated 8:55 AM EDT, Tue April 22, 2014
Eric Sanderson says if you really want to strike a blow for the environment--and your health--this Earth Day, work to get cars out of cities and create transportation alternatives
updated 10:08 AM EDT, Mon April 21, 2014
Bruce Barcott looks at the dramatic differences in marijuana laws in Colorado and Louisiana
updated 4:47 PM EDT, Fri April 18, 2014
Jim Bell says NASA's latest discovery supports the notion that habitable worlds are probably common in the galaxy.
updated 2:17 PM EDT, Fri April 18, 2014
Jay Parini says even the Gospels skip the actual Resurrection and are sketchy on the appearances that followed.
updated 1:52 PM EDT, Fri April 18, 2014
Graham Allison says if an unchecked and emboldened Russia foments conflict in a nation like Latvia, a NATO member, the West would have to defend it.
updated 9:11 AM EDT, Fri April 18, 2014
John Sutter: Bad news, guys -- the pangolin we adopted is missing.
updated 2:25 PM EDT, Mon April 21, 2014
Ben Wildavsky says we need a better way to determine whether colleges are turning out graduates with superior education and abilities.
updated 6:26 AM EDT, Fri April 18, 2014
Charles Maclin, program manager working on the search and recovery of Malaysia Flight 370, explains how it works.
updated 8:50 AM EDT, Fri April 18, 2014
Jill Koyama says Michael Bloomberg is right to tackle gun violence, but we need to go beyond piecemeal state legislation.
updated 2:45 PM EDT, Thu April 17, 2014
Michael Bloomberg and Shannon Watts say Americans are ready for sensible gun laws, but politicians are cowed by the NRA. Everytown for Gun Safety will prove the NRA is not that powerful.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT