I told you I wasn’t done with Marty Makary, author of “Unaccountable:  What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.”  I am flogging away at him because I have predicted that his book will be used by the usual suspects in D.C. and at the usual think tanks as the gospel-truth.  Here is another quote from his book:

“The singer Kanye West’s mother recently went to a surgery center for a routine plastic surgery, developed a rare complication, and died.  In the case of West’s mother, her surgery took place in a freestanding surgery center where there was no adjacent hospital to handle emergencies.  This is now a common scenario.  Patients don’t know and aren’t told, that if something goes wrong, they are going to be up a proverbial creek without a paddle.  When the day comes for me to have an outpatient procedure under general anesthesia, I’ll do it at an outpatient surgery center connected to a hospital.  Thirty-eight percent of outpatient procedures are done today from ambulatory surgery centers with no adjacent hospital.  No matter how good the doctors are, that’s a less safe place to be.”

Let’s break this down.  Never mind that up to this point in his book he has devastated hospitals as actually benefitting financially from the complications they create.  Never mind that he has demonstrated without any doubt by this point in the book that quality in any given hospital is sporadic and unpredictable.  Never mind that he is a pancreatic cancer surgeon and has no clue what working conditions are in an outpatient surgery center.  This point is particularly stinging in that he has eviscerated Dr. DeBakey for stepping outside of his field of expertise to operate on the Shah of Iran.  

This baseless and biased broad stroke judgement is odd and hypocritical coming from an academic surgeon, but not atypical.  For all the talk of being a scientist, his emotional and envious side apparently rules him.  Having authored over a hundred peer reviewed scientific articles you would think that Dr. Makary would have the ability to objectively look at the facts and statistics, particularly in a book where he is cajoling the reader to ask questions and search for the facts, facts many times hidden from view.  

“What is the likelihood of acquiring a serious infection in a free-standing outpatient surgery center as opposed to one operated by a hospital?”  “What is the likelihood of unanticipated death under the same circumstances?”  “What is the likelihood of unanticipated hospital admission following surgery in a free standing as opposed to a hospital ambulatory surgery center?”  “What is the nurse to patient ratio in a free standing outpatient surgery center as opposed to one operated by and in conjunction with a hospital?”  

Why didn’t he go over any of this?  Because he is an academic surgeon with the usual biases and blinders that go along with a job like this.  Why is this so bothersome?  Because he gives lip service to the free market.  Suffice it to say that he is as objective about the free market as he is about free standing outpatient surgery centers.  He is, in my opinion,  less qualified to talk about the free market than Dr. Debakey (a cardiac surgeon) was to operate on the Shan of Iran’s spleen.  

Remember the scene in Rodney Dangerfield’s “Back to School” where the business-savy Dangerfield corrects the business teacher on all of the details he’d left out when considering a business plan, like the political payoffs to politicians and various inspectors and union negotiations?  I would encourage you to think of Makary in this way, as a teacher.  Well-meaning, somewhat effective in his field, but using what credibility his actual skill set has given him to step into an area where he is actually clueless!  

I have seen many doctors do this.  They must be smart.  They are doctors, after all!  Having conquered medical school, don’t they have the brains to give everyone else investment advice?  

As the medical director of a free standing outpatient surgery center, I can tell you that Dr. Makary is flinging his opinion in this area whereas, on the contrary,  in his discussion of hospital quality he relies on facts.  I found his comments very disappointing here as they were possibly a window into his biased rather than objective and scientific mind.  Again, another lost opportunity.  

G. Keith Smith, M.D.