Reading List

A de-programming reading list

Introduction: Some realities about "Health Care"

Some people who are exposed to certain media comment may find no reason to trust doctors to be professional or ethical. For example the question of the day on Channel 10's Live it up was how many doctors sexually abuse their patients. The correct answer was given as being 10%. On the 9am ABC Radio News on 14th August it was reported that 19% of Australian doctors had taken the life of a patient without the patient's consent. Should consumers be asking what the overlap is ? Is there about a 1 in 4 statistical chance that the next doctor you go to for help is one of the above types ? Most sick patients cannot psychologically afford to even consider such a question. A logical need to know has been overcome by the don't want to know effect , encouraged by disinformation from the multi-million dollar public relations arm of today's massive international medical-industrial complex.

Studies in California in the mid 1970's and in New York in 1991 put deaths due to medical negligence as more numerous than the combined deaths due to the road toll plus occupational work related mortality. Thus the true cost of medical negligence injuries and deaths are massive but remain hidden. No comprehensive data is available for Australia. It is very difficult to get official studies done of such matters. The 1995 Quality in Australian Health Care Study used 1992 data from 28 hospitals. But the study was designed so as not to be able to measure negligence as such. A team of doctors and nurses analysed 14,179 patient admissions to a representative set of hospitals. Cases where things had gone wrong (including deaths) where the team found it difficult to justify the bad outcome were classified as adverse events which just should not have occurred. (The next step of trying to decide if the bad outcome was linked to negligence in any way was not done.) Statistical scaling was then applied to yield results applicable to the whole of Australia in 1992. The results indicated that at least 25,000 and possibly as many as 30,000 were permanently injured in 1992 and at least 10,000 and possibly as many as 18,000 patients killed in this way.

Quality Assurance (QA) is not being applied in a conventional manner within medicine. Predicted outcomes as most powerful performance analysis tool for process improvement does not often seem to be used in medicine. Presumably because provider fear levels are just too great ? References to QA in the local medical literature normally conform to a model that misses out the vital fact that QA is about saying first what you INTEND to achieve and then leaving a documentation trail so that you can later see, if you did not reach the goal, why not. This is the 'A' (assurance) in QA. -- the 'Q' refers to quality which Deming ( a founder of engineering QA) says is a performance that meets the specification but does not exceed it. However in the medical version of QA the 'A' seems to stand normally only for assessment. It seems that in many cases medical quality assessment means the following. Data is gathered for some indirect purpose. Often this purpose seems to end with the publication of a report that gathers dust on some shelf. No action is taken as a result and patient injury and fatality rates remain untouched.

To thinking medical consumers the conclusion must be that unless medical consumers themselves take steps to make medical services safer, so putting some real QA 'care' into what doctors and bureaucrats like to call 'Health Care', then it just will not happen.

The problem today is that the vast majority of patients(and journalists) have been mentally programmed by the public relations arm of the medical-industrial complex and only clamour and wave banners for More Health Care Now! , and will even verbally attack those who say true quality in care is important, because they have accepted the propaganda that falsely equates calls for quality measures as increasing costs so reducing access to 'Health Care'. (In other industries it is now axiomatic that Quality saves money but the unsubstantiated claim by some medical industry lobbyists is that "medicine is different".)

Thus calls by groups like MCA of NSW for action to be taken to remove the dangerous 'bad apple' doctors from the system are met by cries that 'the bad apple concept is spurious , the real problem is systemic' and that "You are taking an uncaring position and do not understand at all. If we were to take legal action against doctors as you wish we would end up with the American system of health care that nobody wants, and lots of poor people would lose all access to health care'.

Statisticians tell us that 'Health Care' in dollar terms is now about the biggest of the international mega-industries, outstripping both the international arms and illegal drugs industries. However it is unlikely that these statisticians have access to data to allow them to be able to tell the public if this new leader of the pack is also killing and maiming more people than arms and illegal drugs or not.

We hope that your local library can help you over getting access to some of the books below. We do have to note however that certain books that could offend powerful groups seem to get 'lost' rather fast and note that one member recently found that the book "Killer Doctors" was now listed as 'missing' in all NSW Public Libraries that were supposed to hold a copy. He was informed by the librarian that a copy was being obtained for him from a Victorian library where a copy still was to be found.

The Reading List

Carlson, Rick J. (1975) The End of Medicine , Wiley & Sons Inc.
(Puts a view that registration of individual providers should be replaced by certification, and that a rigorously deprofessionalized system is needed as medical professionalism is a massive threat to the good health of the public.)

Curson, Paul, Dr (1993) How to Survive Your Doctor, Wilkinson Books
(Some plain English diagnosis help from a doctor from the down to earth perspective that: "Doctors with all their optimism, media hype and high technology rarely cure anything.")

Evans, Colin (1993) Killer Doctors, O'mara Books
( Thirteen cases of premeditated murder by physicians who used their medical skills to commit or cover-up their crime.)

Guinther, John (1978) The Malpractitioners, Anchor Press/Doubleday, New York
(Exposure of the medical indemnity insurance pay-out crisis in the USA, showing it to be a myth generated when interest rates fell, and the US indemnity companies had a cash flow crises and thus had to dream up a crisis to boost premiums )

Illich, Ivan (1977) Towards a History of Needs, Pantheon Books
(Section about professional dominance see also this author's other books, notably Medical Nemesis)

Inlander, Charles .B. et al (1988) Medicine On Trial , Prentice Hall , New York
(From the Peoples Medical Society in the USA, the horrors of modern medicine exposed)

Jones, Michael A. (1991) Medical Negligence , Sweet & Maxwell, London)
( Includes comment on the mythology generated by the medical profession about such things as: indemnity cover , negligence, defensive medicine, and the value of medical care. )

Noel, Barbara and Watterson, K. (1992) You Must Be Dreaming , Poseidon Press New York
(An actual account of how a very senior health care provider managed for years to be a serial rapist of his patients.)

Rice, Stephen (1988) Some Doctors Make You Sick, The scandal of medical incompetence , Angus & Robertson
( A local perspective on the horrors of modern medicine. Also covers the death and injuries caused by the Chelmsford Private Hospital doctors in Sydney.)

Slattery. J.P., (1990) The report of the Royal Commission into Deep Sleep Therapy, Sydney.
( The official account of the Chelmsford Private Hospital disaster. Note in spite of death certificate forgery, perjury, and reckless indifference to human life the NSW legal system has failed to get any of the doctors into court. And since then government have changed the law to stop the public having access to the legal system in the way that they did have and that enabled members of the public to expose the Chelmsford scandal.)

Bastian H., (1990) Who's to Blame and Who should Pay ?, Consumers Health Forum of Australia, Canberra ACT.
(Which in part says : A spokesman for the Medical Defence Union in Australia said his organisation would fight claims even though this means that "many seriously injured patients get not a bean in compensation".)

BMJ (1990) British Medical Journal of 29th September 1990
(Research carried out in Florida (BMJ:1990) that showed that 85% of pay-outs on medical negligence were for services provided by only 3% of doctors. A review revealed this 3% had a particularly large number of complaints against them. )

Dugdale, Tony (1989) "Restructuring legal and health services: the challenge to the professions", Professional Negligence, May/June 1989.
( at p97-102 'However, another approach to professionalism is to see professional status as resting not on market control but on quality control. This functionalist approach sees professions as receiving their status, privileges and autonomy from society in return for using their expertise in society's interests, promoting high ethical standards and ensuring quality of service with rigorous disciplinary procedures. On this approach the reform proposals * present a challenge, but of a different kind. They are calling on the professions to deliver their side of the bargain by taking quality seriously. If the professional bodies can rise to the challenge and operate audits, codes of conduct and effective complaints procedures then far from declining they will continue to play a vital role in society.'
* in the context of the UK situation and the government's White Paper 'Working for Patients'.)

Hare, R. M. (1993) "Is medical ethics lost?" , Journal of medical ethics Vol19 p69-70

Illich, I. (1973) Tools for Conviviality , Fontana edition 1979
( For the two watershed theory of how professions evolve to become a menace to the wider community.)

Perinatal Newsletter Aug 1994 , Item in Current Issues : The Tito report (Professional Indemnity Review , Interim report February1994 (PIR))
(Obstetrician-gynaecologists who for top quartile members command annual remuneration of from $320,000 to $550,000 nevertheless object very strongly via their professional body to paying indemnity cover (of about $20,000 (before tax) per year according to the PIR) seeing this as an unjustified impost. "The perinatal profession cannot continue to be used as a de facto social welfare system for the support of these children"
( MCA notes here that a serious conflict of interest must exist for all medical defence funds who finance both defence of the doctor and compensation of the victim. These funds are mutual funds owned by medical professionals who join them for indemnity cover. The ethical problem that this raises is not one that MCA has found any medical professionals willing to clarify ! )

Rees, Stuart J. & Gibbons, M (1986), A Brutal Game : Patients and the doctors' dispute. Angus & Robertson, Sydney
(Relates how NSW patients were used as hostages in the 1980s by medical specialists' as part of power-plays with government over control of medical insurance, doctor's salary levels, and Medicare conditions so as to protect privilege and defend inequality at a time when a NSW Health Minister was using the term "avoidable deaths" to describe what NSW patients faced.)

Relman, A. S. (1988) "Assessment and Accountability: The Third Revolution in Medical Care" New England Journal of Medicine 319 ,1220

Schroder, Jack (1990) Identifying Medical Malpractice, The Michie Company, Charlottesville, Virginia.
"Plaintiff verdicts in medical malpractice cases are the principal impetus to change and improvement in the medical care delivery system. Plaintiff verdicts have done more to improve medical care, to correct abuses in hospitals, and to stop adverse drug effects, than any other force in this country. Medical licensing boards, the U.S. Food and Drug Administration, State Health Departments, and all the forces of Health and Human Services are nothing compared to the impact of the plaintiff verdict. Where social pressures fail, money does not."

Sunday Telegraph (1989) "Unit Angers Doctors" reporter Ron Hicks May 7th
( The NSW State president of the AMA was quoted as saying "It is unacceptable for the public to be given active encouragement to lodge complaints about their health professionals".)

Taylor, Richard (1979) Medicine Out of Control , The Anatomy of a Malignant Technology, Sun Books Melbourne.

Williams, Ron. (1992) Remission Impossible : the future of the Australian Health Industry, Jacaranda Press Milton QL
(Sees a drift to the American system with doctors hardened into 'gatekeepers' mainly seeking profit.)