Kiwi Polemicist

August 28, 2009

• Doctor-Bullies Flourish In Public/State Hospitals

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A friend was telling me about being bullied by a hospital midwife, and this reminded me of the times that I have been bullied by hospital doctors. I believe that bullies flourish in public/state health care. Why so? Before I get to the answer allow me to explain the New Zealand situation.

The health care situation in New Zealand

Basically the state has a near-monopoly on health care. Private hospitals only provide elective and sub-acute procedures, so anything complex or acute (e.g. car crash injuries or a heart attack) goes to a public hospital. I met a guy who had a knee replacement (elective surgery) done in a private hospital, then experienced a pulmonary embolism (an acute, complex, life-threatening condition where there is a blood clot in a lung) as a complication of surgery so was transferred to a public hospital because private hospitals in New Zealand cannot manage this problem. There’s really no escape from the state health care system (chaos?) in New Zealand.

Why do bullies flourish in public/state health care?

Because the staff in a public hospital are effectively in no way accountable to you, the patient.

When you are paying a medical person for their services you are purchasing a portion of their time and that person is beholden to you, just as an employee is beholden to his employer during his hours of employment. When a doctor is paid by the state, using money taken from taxpayers at gun point, that doctor is beholden to whom? Yep, the state.

Allow me to explain. When you – let’s call you Lee – go to a private doctor or other medical professional there is a contract (exchange of promises) between you: you are saying “I will pay you $X if you provide the medical services that I require”. In return the doctor says “I will provide you the medical services that you require if you pay me $X”. Both parties know that the other party can walk away if the promises are broken (breach of contract), and because you are a party to the contract the doctor knows that he must provide what you want in order to receive his profit.

Compare this with a public health care system where the state says to a doctor “I will pay you $X if you provide medical services to Lee”, and the doctor says “I will provide medical services to Lee if you pay me $X”. You the patient, the slab of meat in the bed, are merely incidental to this contract and have no control over it or the parties to it. The doctor knows that he must provide what the state wants – not what you want – in order to receive his profit. If, as is often the case, the medical services that you want or need are different to what the state is willing to provide that’s just too bad.

Why do bullies flourish in public/state hospitals? Because the patients have no effective control over them: in other words, when you go into a public hospital you are the mercy of the staff. Bullies are attracted to situations that give them power: being a doctor or other medical professional gives power, and being a doctor or other medical professional in a public/state hospital gives more power. The bullies know that you are disempowered as a result of being removed from the contractual process by the state’s overwhelming power. They also know that they can get away with bullying, because history shows that “little or nothing” is the usual result when patients complain about state employees.

Josef Mengele is a good example of a state-protected doctor-bully – he’s the Nazi well known for experimenting on humans at Auschwitz-Birkenau. “That can’t happen in New Zealand”, you say. Wrong: what Mengele did is, in my opinion, only a step or two away from what Herb Green did when he experimented on women without their consent or knowledge and killed some of them. I am referring to the “Unfortunate Experiment” at National Women’s Hospital, in which Green did not treat a condition widely believed to lead to fatal cervical cancer in order to see if that was what really happened (details here and here). If Green did what he did with malice aforethought (intent to kill) he would be as much a murderer as Mengele is, but Green most probably had good intentions. Despite this, you can make a good case for saying that Green has blood on his hands.

Do bullies flourish when there is a free choice of health care providers?

Let me speak from personal experience. A few years ago I went to a dentist that was recommended to me and found that he was an unpleasant individual with an arrogant manner. Because the state in no way controls which dentist I go to I never went back to him and he suffered financial loss as a result. That’s how capitalism works: those who don’t provide the best service lose money if the state does not interfere with the free market (I have met many doctors and other medical professionals in public hospitals who are far, far more unpleasant and arrogant than this dentist but, sadly, I have never had the option of voting with my wallet and going to another hospital because the state has interfered with the free market, i.e. taken away my freedom to choose. State institutions are refuges for various forms of life that cannot survive in the real world).

Compare this with my optometrist, who is is very nice, very competent, and has always provided good service. I have a free choice of optometrists, so I keep going back to him because he provides what I want. That’s how capitalism works: those who provide the best service are rewarded with more money (profit). The profit motive is often maligned, but it is a good thing because it results in you and I getting what we want.

In my experience doctors and other medical professionals almost always have a better attitude when they know that I have freely chosen to consult them and bring profit to them. Those who know that I have no choice about who I consult because the state has taken it from me are far more likely to be uncaring, rude, off-hand, bullying, and the like. That’s human nature, i.e. very few people are willing to make an effort and provide good care when they can make little effort and be paid the same amount. Less work, same money – that’s the situation in a state-protected monopoly and it’s a no-brainer for the staff. That’s why going to the DMV, state hospital, city council, etc. is normally so painful.

Do bullies flourish when there is a free choice of health care providers? Common sense and my experience indicates that they do not, because capitalism is a form of natural selection.

In summary
  1. Bullies, be they doctors or other medical professionals, flourish in state/public hospitals because the state has made them effectively unaccountable to their patients and protects them when they do bully.
  2. State disempowerment of individuals leads to gross injustices in medical situations, ranging from bullying to killing.
  3. The profit motive and contracts freely entered into give us protection against doctor-bullies.
  4. Bullies do not flourish when individuals can freely choose their medical provider.
  5. Free choice leads to lots of 🙂 .

Finally, I’d like to say that I have met a few public hospital doctors who are superb clinicians and a pleasure to talk to.

What do you think about that points that I have raised here?

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Related articles:

Why does Obama want to eliminate private health insurance via Single Payer/Universal Health Care?

Everything You Love You Owe to Capitalism

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1 Comment »

  1. […] Doctor-Bullies Flourish In Public/State Hospitals […]

    Pingback by • Dutch court stops teen Laura Dekker sailing around the world « Kiwi Polemicist — August 29, 2009 @ 1:57 pm


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