To start with, I think the concept you are after is agent rather than advocate. Advocacy is only one thing agents do; furthermore, there is a certain type of officer in the public administration called an advocate, and his/her advocacy tends to be on behalf of groups with particular needs in common, rather than individuals, whereas it’s the latter you seem to be interested in. Also, the sorts of deficiencies you want to fix fall under the general heading of ‘principal-agent problem’, which is already an established field of investigation.

The question this research addresses is, at the most general level, when does it make sense to employ an agent, and under what circumstances does an agent act as the principal wants her to. Obviously the agent helps to overcome an information asymmetry, which is why we have lawyers, brokers and buyers’ agents for real estate transactions, and why we get architects to negotiate plans through council. But, just as the sellers of credit, shares, real estate, insurance and so on have an incentive to cheat the buyer, so in principle does the agent, who can take advantage of related informational asymmetries, although in other ways.

I can see this is turning into an essay, which I don’t have time to write, Apart from that, of course you know all this. As long as you can see where I’m coming from and where I’m heading…

As an aside, I’m struck again by the way in which attitudes to the public sector are shaped by personal experiences. I’ve raised this with you in the context of schools, but it seems to apply to hospitals too. Both of my children had difficult and extended deliveries. In both cases we dealt with a succession of midwives, but they were without exception absolutely terrific — competent, professional, caring, ready to answer questions — and we never had the impression that they were anything but our agents in dealing with the difficulties of childbirth. You really need to move to Western Sydney, and you can save your money for theatre tickets or World Vision sponsorships.

Next time it happens, can you email the original to me so I can try it out?

Mr Jacques Geekster – when I try to post a medium long comment – Troppo wont accept it. I have to break it up.

I hope it isnt just a filter for me. [looks over shoulder adjusts tinfoil hat]

i am using Opera

What message do you get from Wordpress?

On the issue of drugs etc. there is (was?) a Melbourne hospital with a natural birthing unit. Mrs D and I went to their sessions and seminars and stuff and listened to (what I thought was) some very scary stuff. The midwives there were basically saying that ‘real women’ pushed it out with no drugs etc. and that medical doctors were all men conspiring against women the deny them the chance to experience real womanhood (I’m paraphasing a bit).

Were these midwives you encountered in the hospital or your own hired midwife?

If you read the above post to assert that midwives are good and doctors and nurses are bad, then I’m sorry to disappoint you, but that’s not the point of the piece.

Yes, in theory. But GPs are just too busy. But you’re right, a well motivated GP could go onto another kind of payment plan and do it. I just don’t know any who do.

It makes good sense to have a health services “fixer’ a good Gp is best I reckon but anyone who knows the system – a nurse relative, or other health worker friend can be a good broker. But as for an outsider “taking charge” in a hospital it’s not on.

The problem with hospital stays is not so much the planned ones where you can think it through but the unplanned ones. Going to hospital is a bit like going to court. When you havent been in the dock much you are likely to be disorientated and confused so its best to have a few visits first or someone who knows the system – like a lawyer. Having a lawyer in lot of minor cases isn’t so much about knowledge of the law as the day to day familiarity with the system. Going into court a few times when you don’t have to is good to calm the nerves and you will perform better before the coming big Royal Commision Into Mortgage Lenders say.

I hope it isn’t just a filter for me. [looks over shoulder adjusts tinfoil hat]

i am using Opera

We had them for both our kids and had discussed them with the birthing unit prior.

Of course they count for nothing if things are going pear shaped. But then who would want to insist that the birth be “drug free” when the woman is shouting “Fuck the plan I am in pain” or “Fuck you men this is hard work” or more seriously when a life is in danger.

Two words – incomplete contracts.

Not too easy to cover all eventualities.

Caroline,

You say “Never ever entrust your health to people who work in large hospitals, without foremostly knowing exactly what they are doing and why, as its alarming how often they dont.” Not too sure how you avoid this when things start looking a little tense in the middle of some procedure – like a delivery.

Worked out well because in the end we were most ably assisted (just under two hours after that exchange) by a lovely junior midwife.

But Sinc’s plan, whilst attractive, would require doctors to listen – some do, but many don’t. The doctor at this birth seemed only really interested in anaesthetic, which my wife didn’t want – but nothing could really convince him of that, it seemed.

I once knew a radiologist, (an ‘actual’ doctor egads,) (who rolled his joints up on his business review mag) who said he loved his work because it paid really, really, really well, and he didn’t have to treat anybody, just deliver them up the bad news and then bid them ‘goodbye’. A real charmer. I’ve known people who in blind trust have put their health into the hands of a cast of health care ‘professionals’ working in big hospitals only to be discharged at the other end and told ‘sorry there’s nothing further we can do’. This is usually about the time they decide that maybe some alternative therapy might be worth a shot.

Never ever entrust your health to people who work in large hospitals, without foremostly knowing exactly what they are doing and why, as its alarming how often they don’t. Most, ‘mean’ well, but can neither afford the time, nor seem to have any aptitude to actually care or (roll your eyes) ‘heal’ anybody. What a quaint old fashioned, ‘alternative’ notion that is–health care professional as healer. Heh.

It sounds in your case that a former matron midwife had the strength of determination and personality to sort out an officious sister in charge, but its a sorry state of affairs when it comes down to an individual’s strength of personality, whether professional or patient, as to the chances of them getting the right (ahem) ‘care’ service.