Abstract

KIE: In comments stimulated by Erica Bates' book Health System and Public Scrutiny: Australia, Britain, and the United States (New York: St. Martin's; 1983), the author discusses medicine's lack of responsiveness to criticism from patients and peers. Lay critics focus on observable medical behavior and seldom delve into the "heart of medicine," the clinical consultation. Because of centuries of an overcrowded market, the consultation has been designed to "mystify rather than educate, to disguise spontaneous improvement as the effect of treatment, and iatrogenic illness as the effect of disease." Before 1935 medicine was cheap and relatively harmless; however, now it is expensive and potentially destructive and therefore demands discriminate use. Unfortunately, the retention of brief consultations hinders accountability. If practitioners were answerable to their patients, a beginning could be made toward satisfying a demand for public scrutiny.