In 2012, Johns Hopkins surgeon Marty Makary wrote an essay in the Wall Street Journal about “the disturbing closed-door culture of American medicine.” According Makary, one of the primary reasons so many people die from medical errors is simply the refusal of doctors to criticize the mistakes of their colleagues. Makary describes one particularly doctor, who had been nicknamed HODAD (“Hands of Death and Destruction”). According to Makary: “His operating skills were hasty and slipshod, and his patients frequently suffered complications. This was a man who simply should not have been allowed to touch patients. But his bedside manner was impeccable[.]” So his patients repeatedly suffered complications and extended hospital stays. As a result, there are enough unnecessary medical deaths each week to fill four jumbo jets. This is a terrifying thought.
Makary’s first solution is simply tracking information. “Every hospital should have an online informational “dashboard” that includes its rates for infection, readmission (what we call “bounce back”), surgical complications and “never event” errors (mistakes that should never occur, like leaving a surgical sponge inside a patient).” Second, he says doctors should be scored on their “safety culture,” to encourage nurses and doctors to speak up when they fear a colleague is making (or has made) a mistake. Third, he says more parts of doctors’ practices should be videotaped, to provide better accountability. Fourth, he says patients should be able to review the surgeon’s notes easily, to catch communication errors. Fifth, he says hospitals should stop trying to silence criticism with contractual gag orders?
So, how far have we come? Do you see any of this information on your hospital’s website?
Makary is dear to our heart at Friedman Rubin because he is also a longtime critic of the da Vinci robot, which has been responsible for massive, unnecessary injuries to several of our clients. Makary argues that da Vinci injuries are significantly underreported. This comports with our experience: none of our burn cases were reported by the company (Intuitive Surgical) to the FDA until lawsuits were filed. The next trial of those cases will take place in King County, Washington in February.