Skip to main content

Is your hospital hurting you?

By Marty Makary, Special to CNN
January 2, 2013 -- Updated 2103 GMT (0503 HKT)
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
July 30, 2014 -- Updated 1941 GMT (0341 HKT)
Stuart Gitlow says pot is addictive and those who smoke it can experience long-term psychiatric disease.
July 30, 2014 -- Updated 1645 GMT (0045 HKT)
Gabby Giffords and Katie Ray-Jones say "Between 2001 and 2012, more women were shot to death by an intimate partner in our country than the total number of American troops killed in the Iraq and Afghanistan wars combined."
July 29, 2014 -- Updated 2357 GMT (0757 HKT)
Alan Elsner says Secretary Kerry's early cease-fire draft was leaked and presented as a final document, which served the interests of hard-liners on both sides who don't want the Gaza war to stop.
July 30, 2014 -- Updated 1158 GMT (1958 HKT)
Vijay Das says Medicare is a success story that could provide health care for everybody, not just seniors
July 30, 2014 -- Updated 1818 GMT (0218 HKT)
Rick Francona says Israel seems determined to render Hamas militarily ineffective.
July 30, 2014 -- Updated 1743 GMT (0143 HKT)
S.E. Cupp says the entrepreneur and Dallas Mavericks owner thinks for himself and refuses to be confined to an ideological box.
July 30, 2014 -- Updated 1311 GMT (2111 HKT)
A Christian group's anger over the trailer for "Black Jesus," an upcoming TV show, seems out of place, Jay Parini says
July 30, 2014 -- Updated 2028 GMT (0428 HKT)
LZ Granderson says the cyber-standing ovation given to Robyn Lawley, an Australian plus-size model who posted unretouched photos, shows how crazy Americans' notions of beauty have become
July 30, 2014 -- Updated 1939 GMT (0339 HKT)
Carol Dweck and Rachel Simmons: Girls tend to have a "fixed mindset" but they should have a "growth mindset."
July 28, 2014 -- Updated 1156 GMT (1956 HKT)
A crisis like the Gaza conflict or the surge of immigrants can be an opportunity for a lame duck president, writes Julian Zelizer
July 26, 2014 -- Updated 1822 GMT (0222 HKT)
Carol Costello says the league's light punishment sent the message that it didn't consider domestic violence a serious offense
July 28, 2014 -- Updated 1251 GMT (2051 HKT)
Danny Cevallos says saggy pants aren't the kind of fashion statement protected by the First Amendment.
July 28, 2014 -- Updated 1852 GMT (0252 HKT)
Margaret Hoover says some GOP legislators support a state's right to allow same-sex marriage and the right of churches, synagogues and mosques not to perform the sacrament
July 28, 2014 -- Updated 1831 GMT (0231 HKT)
Megan McCracken and Jennifer Moreno say it's unacceptable for states to experiment with new execution procedures without full disclosure
July 30, 2014 -- Updated 1744 GMT (0144 HKT)
Priya Satia says today's drones for bombardment and surveillance have their roots in the deadly history of Western aerial control of the Middle East that began in World War One
July 28, 2014 -- Updated 1635 GMT (0035 HKT)
Jeff Yang says it's great to see the comics make an effort at diversifying the halls of justice
July 26, 2014 -- Updated 1555 GMT (2355 HKT)
Rick Francona says the reported artillery firing from Russian territory is a sign Vladimir Putin has escalated the Ukraine battle
July 27, 2014 -- Updated 1822 GMT (0222 HKT)
Paul Callan says the fact that appeals delay the death penalty doesn't make it an unconstitutional punishment, as one judge ruled
July 24, 2014 -- Updated 2225 GMT (0625 HKT)
Pilot Robert Mark says it's been tough for the airline industry after the plane crashes in Ukraine and Taiwan.
July 25, 2014 -- Updated 1510 GMT (2310 HKT)
Jennifer DeVoe laments efforts to end subsidies that allow working Americans to finally afford health insurance.
July 26, 2014 -- Updated 1533 GMT (2333 HKT)
Ruti Teitel says assigning a costly and humiliating "collective guilt" to Germany after WWI would end up teaching the global community hard lessons about who to blame for war crimes
July 25, 2014 -- Updated 1245 GMT (2045 HKT)
John Sutter responds to criticism of his column on the ethics of eating dog.
July 25, 2014 -- Updated 1302 GMT (2102 HKT)
Frida Ghitis says it's tempting to ignore North Korea's antics as bluster but the cruel regime is dangerous.
July 25, 2014 -- Updated 1850 GMT (0250 HKT)
To the question "Is Putin evil?" Alexander Motyl says he is evil enough for condemnation by people of good will.
July 24, 2014 -- Updated 1803 GMT (0203 HKT)
Laurie Garrett: Poor governance, ignorance, hysteria worsen the Ebola epidemic in Sierra Leone, Guinea, Liberia.
July 24, 2014 -- Updated 1349 GMT (2149 HKT)
Patrick Cronin and Kelley Sayler say the world is seeing nonstate groups such as Ukraine's rebels wielding more power to do harm than ever before
July 23, 2014 -- Updated 2205 GMT (0605 HKT)
Ukraine ambassador Olexander Motsyk places blame for the MH17 tragedy squarely at the door of Russia
July 24, 2014 -- Updated 1142 GMT (1942 HKT)
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
July 24, 2014 -- Updated 1853 GMT (0253 HKT)
Les Abend says, with rockets flying over Tel Aviv and missiles shooting down MH17 over Ukraine, a commercial pilot's pre-flight checklist just got much more complicated
July 24, 2014 -- Updated 1317 GMT (2117 HKT)
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
July 24, 2014 -- Updated 1637 GMT (0037 HKT)
Gerard Jacobs says grieving families and nations need the comfort of traditional rituals to honor the remains of loved ones, particularly in a mass disaster
July 24, 2014 -- Updated 1413 GMT (2213 HKT)
The idea is difficult to stomach, but John Sutter writes that eating dog is morally equivalent to eating pig, another intelligent animal. If Americans oppose it, they should question their own eating habits as well.
July 23, 2014 -- Updated 1630 GMT (0030 HKT)
Bill van Esveld says under the laws of war, civilians who do not join in the fight are always to be protected. An International Criminal Court could rule on whether Israeli airstrikes and Hamas rocketing are war crimes.
July 30, 2014 -- Updated 1209 GMT (2009 HKT)
Gordon Brown says the kidnapped Nigerian girls have been in captivity for 100 days, but the world has not forgotten them.
ADVERTISEMENT