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Salient: Victoria University Students' Paper. Vol. 27, No. 14. 1964.

NZ Medicine Very Sick

page 8

NZ Medicine Very Sick

Geiringer And The "Medical News"

Q: Tell us about yourself.

G: You mean personal details?

Q: Just a brief idea of what you're doing here.

G: I've been in New Zealand five years now. I came here to take up a post at the medical school. After three years I wasn't reappointed, and so I am now in general practice in Petone.

I've done a lot of research, hospital work, teaching and general practice; and I've worked in so many different countries that I must be one of the very few doctors in this country (perhaps the only one) who has this kind of varied experience of every type of medicine—academic, research, and general practice—not only in one country, but in most of the countries that New Zealand is either trying to model itself on or is trying to learn something from.

Q: Was this the idea behind the New Zealand Medical News?

G: Well, not the idea, but one justification for doing it. People might say who the hell is he—why should he tell us how' to do it. Of course, medical politics are very difficult, and the answers change as medicine is changing. Even so, if you take a man who has been practising medicine in the recent past in a number of different communities, the States. Great Britain. France, Canada and so on and compare him with the kind of people who lay down the rules as to how medicine should be organised, mainly politicians and public health people and maybe one or two specialists who have been sitting on their behinds in the same place for twenty or thirty years, it's obvious that, other things being equal, his opinions are likely to be a little more realistic than theirs. Its that which gave me the confidence to go and tell them what to do.

Q: What motivated you to start the Medical News?

G: It was a clear course of events that led to the publication of the Medical New's. Before coming to Dunedin I had become interested in the problems of community medicine, and how a state-run health service can function and how it can run into trouble and so on. I had published something about this in Britain, before I came out. Naturally when I got to Dunedin, I took a good hard look at the medical school and after three years I thought, that I knew enough about it to write a paper on it.

It was a critical but not destructive paper. It listed certain defects, but also proposed the necessary remedies. It amounted really to this—that Dunedin is too small a town to be able to train a hundred and twenty students a year for medicine.

I wrote it for the medical students' annual publication, and they were pleased, but the Dean of the Medical School was horrified by it. Alter an interview' with the Dean the student editor was most distressed and told me that he was afraid to go ahead with the publication. 1 said "don't publish it, I'll publish it in the New Zealand Medical Journal."

It was obviously a very good paper for the NZMJ—it was carefully written, it went into the whole problem of medical education and it made certain proposals. Even if one didn't agree with it, it provided an excellent basis for discussion. It was the kind of paper that any reasonable medical journal would want, to publish, the kind of paper, for example, which I wrote for the Lancet about the British National Health Service, just before I came to this country.

To my surprise, the NZMJ turned down my paper without an explanation. This was very odd because in the medical and scientific world, when an editor doesn't want to publish a thing, he always gives his reasons.

At that time I wasn't aware of the workings of the inner circle which rules New Zealand medicine. New Zealand—wise I was still very naive. I don't like being gagged, so I went to a printer and published the thing at my own expense. I distributed it in the Medical School, and to doctors in the country and to MPs and people like that. The response was amazing.

That there was a lot of agreement with what I said wasn't surprising—it was the first comprehensive paper on medical education in New Zealand which had been published for many years. What was surprising and indeed, to me, shocking, was that people wrote to me congratulating me on my courage, as if I had done something which deserved the Victoria Cross.

These pitiful letter? came from all kinds of people—professors, public servants, leading people in New Zealand medicine. GP's in small country towns and they all had the same idea, that for a man to write a paper which does nothing else but put down his own opinion on a certain subject requires a lot of courage, and that this was a tremendous thing to do.

It was only then that I realised that not only the medical school, hut all of New Zealand medicine was very sick. There is a superstition that any man who opens his mouth and says what he thinks is in for it, and that something terrible will happen to him, and that the big boys will "get him."

There is a certain amount of justification for this belief, but I think that most of it is just an ingrown fear of expressing themselves. It is one of the major maladies of New Zealand. You've only got to read the daily papers and the mealy mouthed kind of rubbish they print—the banning of Washday at the Pa is a very good example. Kiwis are completely dishonest about everything.

This may well be enough, I suppose, outside medicine, but inside medicine it is intolerable, because medicine is such a fast moving subject. Terrible things are bound to happen when you have a medical system where people don't dare to speak. The only medical journal in the country was run in such a way that free expression of opinion in it was impossible.

At first I only knew it from ray own experience, but when I looked into the matter, there were many instances that showed that the Medical Journal indulges in a systematic suppression of truth. Any uncomfortable fact of New' Zealand medical life was just not mentioned.

At that stage I was asked by the New Zealand Listener to write an article on New Zealand medicine. I wrote it on the boat to England, and outlined the main problems of New Zealand medicine, and the mam answers as I saw them.

Having been commissioned by him. I sent this article to Mr, Holcroft from Panama. That was "The Elephant and the Monkey." He refused to publish it. The letter which he wrote me was an interesting document of evasion but, at any rate, it seemed that he too was scared to have a spade called a spade in his journal.

It's quite likely that, if he hod published it, I would have felt that I had had my say and that would have been the end of it.

But when I heard of the refusal I began to feel that one of the most important things a man could do in New Zealand was to break through this conspiracy of silence on matters of public importance. This applies to fields other than medicine, but since I was particularly qualified to do it for medicine, I thought that I would come back and start the Medical News.

Q: What has been the response from the Medical Journal?

G: In the sixteen months in which it existed, the Medical News consistently attacked the NZMJ and its editor. But if you were to read the Journal, you would find no mention of any of that. This was part and parcel of their policy to make the NZMN look as if it wasn't worth taking any notice of. But whether they liked it or not the Medical News became, during those 16 months the most important factor in the medico-political life of the country.

Q: You don't think they changed their editorial policy at all?

G. Oh, yes, they did. They tried to pretend that the Medical News didn't exist, but they had to modify their own editorial policy just the same. The number of critical letters which they published grew steadily, until, towards the end of the time of the NZMN, a lot of frankly critical and controversial letters were at last published. The editorials began to be a bit more realistic in dealing with the deficiencies of the system and the possible causes. This was due to the fact that one or two of the editors, who had always been quite reasonable people, had at last been allowed some freedom to act.

The Medical Journal became aware of the fact that the Medical News couldn't be killed by silence, and that a growing number of doctors were convinced of the justice of the remarks that were published in the Medical News, and so the Journal changed. If the Medical News had gone on the Journal would have changed even more.

This is the beauty of publishing. It must have an influence When I stopped the News 1 warned the profession that without an independent weekly journal they would slide back again into the old position. You can't maintain efficient expression of public opinion when you have a monopoly, even with the best will in the world: and the best will in the world isn't present in these circles. If one journal hogs the field then gradually very important aspects of very important problems will fall under the table and never be mentioned.

Q: Do you think there is likely to be an independent medical journal started in the near future, by someone else?

G: Lots of doctors agree that such a thing is necessary. I also know that some are thinking about publishing, but whether they will proceed to action I don't know. I have no doubt that within the next few years an independent medical journal will be published in New Zealand.

But we need it quickly because there are lots of urgent medical problems that have to be brought out into the open. Otherwise the New Zealand health service is going to deteriorate to such an extent that the next election will see it a playball of party politicians.

New Zealand doctors, like other New Zealanders, lack in civic enterprise. They tend to be private people. When I started publishing I knew, of course, hat New' Zealand doctors were a bit that way. I'm not blaming them. It's tied up with the whole social and political structure of the country. I concluded, however, that they probably were also too stupid to know what was going on. This was not so. As soon as I published, I found that most doctors knew exactly what w'as going on, and were very glad to have somebody write about it. There was a large amount of agreement with everything I said. But as for sticking out their own necks, or doing something to bring about what they themselves knew should be done, that's a different story.

Q: What about the effect on the medical bureaucracy?

G: Whilst it was published, the Medical News effect was beneficial—they were on their toes, they were anxiously waiting for the next copy, they learned a lot from it, and quite a few' things happened in the course of the year, which, quite obviously, got their first shove from the Medical News.

Also, which may or may not be a bad thing, a number of medical high ups must have slightly suffered in their health from the effects of the paper—I'm sure that it's shortened one or two lives by a month or two and that could perhaps be quite a good thing, letting younger blood in.

It's very difficult to judge the exact effect of any newspaper. It's a matter of faith, although not of blind faith. The main benefits of publication are negative ones. The sum total of the things that people don't do, don't say and the abuses that don't occur in a country where there is an independent paper constitute the main benefit of a free press.

I could point out two or three dozen things that happened because of the NZMN. but I'm quite sure that there are a hundred undesirable things which Would have occurred if the Medical News hadn't been published. Indeed, one could feel as the year went on how the general atmosphere within the medical profession became freer and less oppressive.

Q: I believe you are writing a book at the moment.

G: Well, it's not quite true to say that I'm writing it at the moment. The first thing I have to write is a report on the main problems of New Zealand medicine. I have learned an awful lot in doing this journal—came into contact with hundreds of people I didn't know' before, had to look into various hospitals and other problems.

I want to write this report for the New Zealand public to show them what stage the health service has reached, what its main defects are what the problems of a community health service are and what the next phase of it should be, to keep it efficient and not too expensive and so on.

This I want to bring out quickly, whilst I still have it all clear in my mind. I want to throw that into the marketplace as soon as possible because important changes in the structure of New Zealand community health services are overdue, and the people are quite ignorant on these matters. After that I want to relax a little, by writing a book about the inner realities of this curious country, and I might call it "New' Zealand—What Everybody Knows."