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Regulating Doctors (Civil Society) Paperback – June, 2000
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Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
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The quality of each of the papers is very high under the editorship of David Gladstone and is a useful contribution to the continuing debate over healthcare which dominates social policy thinking in the major western industrialised nations.
Whithin the domestic British political system, at least to my knowledge within the Conservative party, one of the easiest ways to gain a voice was to denounce a conference motion as not going far enough. In the case of this tract it is an easy enough target. Whilst it is certainly true that consumers have made significant advances in exposing the doctor's closed shop to public view, albeit in the light of a series of tragedies which befell patients, the closed shop still exists. It is certainly an improvement that the professional body which governs doctors' performance has instituted reforms but that in itself is neither a necessary nor suffient condition for the changes that are required to occur.
This is the only criticism I have of the book but I feel that it is a crucial one. The mission of the Institute for the Study of Civil Society is to examine the institutions and institutional structures compatible with balancing the role of the state such that politics does not dominate. Here I feel that more radical ideas need to be considered rather than gradualist reforms.
The Thatcher governments introduced the notion of competition into healthcare provision which hitherto had been provided by the monolithic entity of the Nationalised Health Service. Rather than tinker, the contributors should think the unthinkable to break the stranglehold of doctor's monopoly power and introduce competitive elemnts into all aspects of medical provision. The effects of such competition would provide more realistic benchmarks of performance together with transparent processes by which the consumers of health, patients, hospitals, administrators etc could more accurately judge quality and cost of that provision.
Not to be churlish, these papers are somewhat of a step in the right direction nut the authors ought not to be cowed by the medical establishment in serious consideration of badly needed radical reform in healthcare provision.