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 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.
updated 9:28 AM EDT, Thu April 17, 2014
Ruben Navarrette says Steve Israel is right: Some Republicans encourage anti-Latino prejudice. But that kind of bias is not limited to the GOP.
updated 7:23 PM EDT, Wed April 16, 2014
Peggy Drexler counts the ways Phyllis Schlafly's argument that lower pay for women helps them nab a husband is ridiculous.
updated 12:42 PM EDT, Wed April 16, 2014
Rick McGahey says Rep. Paul Ryan is signaling his presidential ambitions by appealing to hard core Republican values
updated 11:39 AM EDT, Wed April 16, 2014
Paul Saffo says current Google Glasses are doomed to become eBay collectibles, but they are only the leading edge of a surge in wearable tech that will change our lives
updated 2:49 PM EDT, Tue April 15, 2014
Kathleen Blee says the KKK and white power or neo-Nazi groups give haters the purpose and urgency to use violence.
updated 7:56 AM EDT, Wed April 16, 2014
Sen. Sheldon Whitehouse and Rep. Henry Waxman say read deep, and you'll see the federal Keystone pipeline report spells out the pipeline is bad news
updated 7:53 AM EDT, Wed April 16, 2014
Frida Ghitis says President Obama needs to stop making empty threats against Russia and consider other options
updated 5:29 PM EDT, Tue April 15, 2014
Peter Bergen and David Sterman say the Kansas Jewish Center killings are part of a string of lethal violence in the U.S. that outstrips al Qaeda-influenced attacks. Why don't we pay more attention?
updated 12:41 PM EDT, Tue April 15, 2014
Danny Cevallos says families of the passengers on Malaysian Airlines Flight 370 need legal counsel
updated 11:23 AM EDT, Mon April 14, 2014
David Frum says Russia is on a rampage of mischief while Western leaders and Western alliances charged with keeping the peace hem and haw
updated 7:56 AM EDT, Mon April 14, 2014
Most adults make the mistakes of hitting the snooze button and of checking emails first thing in the morning, writes Mel Robbins
updated 1:54 PM EDT, Mon April 14, 2014
David Wheeler says as middle-class careers continue to disappear, we need a monthly cash payment to everyone
updated 7:55 AM EDT, Mon April 14, 2014
Democrats need to show more political spine when it comes to the issue of taxes.
updated 11:55 AM EDT, Mon April 14, 2014
Donna Brazile recalls the 50th Anniversary of the Civil Rights Act as four presidents honored the heroes of the movement and Lyndon Johnson, who signed the law
updated 9:17 AM EDT, Mon April 14, 2014
Elmer Smith remembers Chuck Stone, the legendary journalist from Philadelphia who was known as a thorn in the side of police and an advocate for the little guy
updated 2:56 PM EDT, Sun April 13, 2014
Al Franken says Comcast, the nation's largest cable provider, wants to acquire Time Warner Cable, the nation's second-largest cable provider. Should we be concerned?
updated 11:22 AM EDT, Fri April 11, 2014
Philip Cook and Kristin Goss says the Pennsylvania stabbing attack, which caused grave injury -- but not death, carries a lesson on guns for policymakers
updated 3:06 PM EDT, Fri April 11, 2014
Wikipedia lists 105 football movies, but all too many of them are forgettable, writes Mike Downey
updated 10:32 AM EDT, Fri April 11, 2014
John Sutter and hundreds of iReporters set out to run marathons after the bombings -- and learned a lot about the culture of running
updated 12:49 PM EDT, Fri April 11, 2014
Timothy Stanley says it was cowardly to withdraw the offer of an honorary degree to Ayaan Hirsi Ali. The university should have done its homework on her narrow views and not made the offer
updated 10:16 AM EDT, Fri April 11, 2014
Al Awlaki
Almost three years after his death in a 2011 CIA drone strike in Yemen, Anwar al-Awlaki continues to inspire violent jihadist extremists in the U.S, writes Peter Bergen
updated 9:21 PM EDT, Fri April 11, 2014
David Bianculli says Colbert is a smart, funny interviewer, but ditching his blowhard persona to take over the mainstream late-night role may cost him fans
updated 1:31 PM EDT, Thu April 10, 2014
Rep. Paul Ryan says the Republican budget places its trust in the people, not in Washington
updated 5:28 PM EDT, Thu April 10, 2014
Aaron David Miller says Obama isn't to blame for Kerry's lack of progress in resolving Mideast talks
updated 11:22 AM EDT, Mon April 14, 2014
David Weinberger says beyond focusing on the horrors of the attack a year ago, it's worth remembering the lessons it taught about strength, the dangers of idle speculation and Boston's solidarity
updated 12:32 PM EDT, Thu April 10, 2014
Katherine Newman says the motive for the school stabbing attack in Pennsylvania is not yet known, but research on such rampages turns up similarities in suspects and circumstances
updated 2:39 PM EDT, Wed April 9, 2014
Wendy Townsend says the Rattlesnake Roundup -- where thousands of pounds of snakes are killed and tormented -- is barbaric
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT