I spoke with Makary about his decision to speak out about these issues and his vision of a reformed, patient-driven health care system.
You argue that you're talking about problems that everyone in medicine knows about, but that there's a culture of silence surrounding it all. Why are
you speaking out now, and what are the repercussions of you bringing these issues to light going to be? Do we need to worry about there being an AMA
version of a fatwah issued against you?
Well the way I see it is that, increasingly over the last couple of years, we as doctors have been much more open in talking about our problems. I'm part
of a generation that's willing to admit that we as a profession have made mistakes that have resulted, in part, in a loss of the public trust. There's been
more discussion about medical errors, which are now recognized in top journals like the New England Journal of Medicine to be occurring in 1 in 4 hospitalized patients.
I see the issue of quality to be one of those issues that we need to be open and honest about, and that doctors are starting to be open and honest about.
The fact that a hospital with a good reputation can have a complication rate that's five times higher than another good hospital in the area -- that's a
subject that gets little air time, and even worse, that the public doesn't know much about, because the public has no information to make decisions about
where to seek their care. So they are walking blind into a hospital where research now shows the differences in quality are massive.
So I think the bigger subject is, if we're going to get serious about health care costs in the United States, we need to address the massive differences in
the quality of health care among everyday hospitals. We're not talking hospitals on the brink of closing, or hospitals that nobody goes to -- we're talking
about mainstream hospitals. And we need to address the 20 to 30 percent of health care that's unnecessary. I think talking about health care, without
addressing the 20 to 30 percent of health care expenditures that are unnecessary, is just talking about how to pay for a broken system differently, and not
how to fix the broken system.
The impression I got is that this is really a critique of the system, rather than just you calling out bad doctors.
Yes, we've got good doctors working in a bad system. Hospitals are told they need to fill their empty beds, so they fill their empty beds. Doctors are told
they need to see more patients, so they see more patients. Surgeons are told to do more operations, so they do more operations. So everybody's doing their
job -- the problem is it's a bad system, and we need to redesign the jobs.
A big problem, from the patient's end, seems to be that we just have faith that our doctors know what's best for us, and maybe don't know the right
questions to ask of them. What could the consequences of undermining this authority, and giving patients more power, be?