The doctor is out

Both my mother and my former wife thought their doctors were gods. They would do anything they were told to do, would submit to any procedure and take any medicine that was prescribed because of their heartfelt belief that the doctor could do no wrong. I criticized them often for their messiah perceptions but the criticism always fell on deaf ears. And I know many other people who feel the same way.

Most people believe if they have a physical malady, all they have to do is go to the doctor, tell him or her about it, the malady will be properly diagnosed and procedures to cure the malady will begin immediately with an expected good outcome. But often times a diagnosis is wrong, and if the diagnosis is wrong, then the treatment and the medicine will be wrong too. I've long believed that medicine is still more of an art than a science but I had no real evidence to support that opinion. As a social scientist, I depend on facts rather than opinions and the facts just weren't there to support my perspective.

There was a reason for that.

A new book just published by medical doctor Marty Makary for the first time pulls the curtain back on what goes on in doctor's offices and hospitals around the country. The long title of his book alerts you to what's inside. It's called Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.

In a study he recently conducted, his team asked hospital employees, "Would you feel comfortable receiving medical care in the unit in which you work?" At more than half of the hospitals he surveyed, the majority of health care workers said no. And to the question of whether their hospital gives priority to what's best for the patient, again, in more than half of the hospitals surveyed, the majority of health-care workers said no.

His conclusion was that everyone who works in medicine knows about the problem but few talk about it. His anecdotal evidence reports that one heart surgeon at a well know heart hospital had six consecutive deaths during routine bypass surgery. Yet the doctor continued to do them because the senior partners were very protective of him and whenever one of his "accidents" was brought up at a peer review conference, they attributed the death to some extenuating patient circumstance. In other words, they covered up for him.

A female cardiologist in Wisconsin did a study of her own and found that 29 percent of heart echo interpretations are incorrect. She presented the results of her study at a national cardiology conference and was subsequently fired from the hospital she practiced in.

Harvey Fineberg, M.D., president of the Institute of Medicine and former dean of the Harvard School of Public Health, says that between 20 and 40 percent of our entire health care expenditure is paying for fraud and unnecessary treatment. While patients are encouraged to think that the health care system is competent and wise, it's actually more like the Wild West.

The reason for our ignorance is simple. A hospital's outcomes are hidden from the public. Neither consumers nor payers have any way of measuring whether the medicine and treatment they're getting is good, adequate, or even safe. Medicine's lack of accountability creates an institutional culture that results in overtreatment, increased risk, and runaway costs.

And finally, the most damning evidence came from a national surgeons' conference in which Harvard surgeon, Dr. Lucian Leape, opened the keynote speech by asking the thousands of doctors there to raise their hand if they knew of a physician they work with who should not be practicing because he or she is too dangerous. Every single doctor in attendance raised their hands.

So they know but we don't. And because we don't, the misdiagnoses continue. And the unnecessary and sometimes invasive procedures continue. And the high cost of medical care continues. And unnecessary deaths continue.

Only when doctors and hospitals become totally transparent with the public will these things get better. But to do that would require outing colleagues and friends and I don't see that happening anytime in the near future. In the meantime, healthcare will continue to be a crapshoot because we don't have any way of knowing whether we have a good doctor or a bad one until it's too late.