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.
Curson, Paul, Dr (1993) How to Survive Your Doctor, Wilkinson Books
Evans, Colin (1993) Killer Doctors, O'mara Books
Guinther, John (1978) The Malpractitioners, Anchor Press/Doubleday, New York
Illich, Ivan (1977) Towards a History of Needs, Pantheon Books
Inlander, Charles .B. et al (1988) Medicine On Trial , Prentice Hall , New York
Jones, Michael A. (1991) Medical Negligence , Sweet & Maxwell, London)
Noel, Barbara and Watterson, K. (1992) You Must Be Dreaming , Poseidon Press New York
Rice, Stephen (1988) Some Doctors Make You Sick, The scandal of medical incompetence ,
Angus & Robertson
Slattery. J.P., (1990) The report of the Royal Commission into Deep Sleep Therapy, Sydney.
Bastian H., (1990) Who's to Blame and Who should Pay ?, Consumers Health Forum of Australia,
BMJ (1990) British Medical Journal of 29th September 1990
Dugdale, Tony (1989) "Restructuring legal and health services: the challenge to the professions",
Professional Negligence, May/June 1989.
Hare, R. M. (1993) "Is medical ethics lost?" , Journal of medical ethics Vol19 p69-70
Illich, I. (1973) Tools for Conviviality , Fontana edition 1979
Perinatal Newsletter Aug 1994 , Item in Current Issues : The Tito report (Professional Indemnity
Review , Interim report February1994 (PIR))
Rees, Stuart J. & Gibbons, M (1986), A Brutal Game : Patients and the doctors' dispute. Angus &
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,
Sunday Telegraph (1989) "Unit Angers Doctors" reporter Ron Hicks May 7th
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
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