During my practice as a surgeon, I have encountered dysfunctional conduct and systems over the years, mostly due to the increasing commercialisation of health care. I have also seen, studied and been involved in addressing social dysfunction in another country before I came to Australia.

Over the past 20 years, I have been involved as a whistleblower and critic of the corporatisation of health care. The Corporate Medicine website was started in 1996. It sought to provide information about the large US medical megacorps targeting Australia's health system.

When US aged care corporations entered Australia, I included them. During this period I wrote about health care companies in Australia, and later gathered information about US and Australian aged care companies on the web site. I no longer update the Corporate Medicine website, but I maintain my interest in aged care.

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Approaching problem situations

As indicated on the About page, I grew up in a paternalistic colonial society then lived in a town where the sentiments were pro-Nazi and the walls were adorned with swastika graffiti.  The horrors of the holocaust, were accompanied by the cruelty of the Japanese, and the horrors of Russian and Chinese communism.  I lived through the development of apartheid.  Since then we have had genocides in Europe and in Africa, the rise of fundamental Islam, the resurgence of fundamentalist Christianity in the USA and the advent of Donald Trump in that country.

My interest in belief systems and ideology ideology started early as I could never understand how such a large number of people even a whole country could become so deeply committed to irrational beliefs that they would kill millions of their own citizens and at other times themselves.  This could not be something done by isolated people.  It was a universal human problem that we all had.  So I became interested in what people believed in and have tried to see their actions within that context.  The great mistake we make is to call people evil or terrorists when in fact they believe implicitly in something and don't challenge those beliefs.  Most are caught up in it and believe that they are doing the right thing. Too often our problem is not villains but people who believe and have no doubts.

Furthermore, if you look around you see that every one of us, in our everyday lives, come to believe in things and we do the things we do in life because of them.  Many of them are irrational  even when they lead to good outcomes and not bad ones. Most are half truths or limited insights from a particular sphere of activity where they work that we then generalise.  We apply the ideas to everything we do.  These are the ideas that allow us to understand the world we live in and which give our lives meaning.  We cannot do without them so we are trapped. We have to learn to manage them and the evidence shows that we are singularly lacking in insight and do it very badly.

So we live by and through our beliefs and this extends from the small personal things we do, through a range of more complex beliefs to the great global ideologies of democracy, capitalism, communism, socialism and the perils of racism, sexism and ageism.  Many are beneficial and others are harmful, at least to some.   Most do not end up with piles of bloody bodies and mass graves, but there is a lot of suffering and dysfunction along the way.  While Nazi Germany and aged care may be worlds apart in what they wanted to achieve and in what they have done, they are both human activities.  Nazi Germany provides very important insights into how we humans behave when we believe in something and don't listen to what others who don't believe are saying. The aged care system we have today is a consequence of our beliefs and our not listening to the warnings made by critics.

You would think that by now we would all be acutely aware of the risks that our beliefs will get out of hand and critically examine any new ideas we have, listening carefully to our critics and proceed cautiously looking out for potential problems. But instead we seem to do the very opposite.  We form groups of true believers who reinforce each other.  We attack and discount our critics and their arguments.  We sell our ideas with rhetoric and catch phrases. We don’t collect information to resolve issues and when bad things happen we don’t see them, rationalise them away or angrily reject them.  And when we do these things we have no doubt that we are right. 

Democracy is a belief system that tries to address this problem, yet we have increasingly structured our democracy in such a way that belief promoted by catchphrases becomes the recipe for success.  Money rather than rational argument, and wealth rather than social wellbeing determines outcomes.  The technology which should protect us by keeping us informed becomes the vehicle.

So with this background I don’t look around for someone to blame when things go wrong. Instead I look at what people who are doing these things believe to see what the relationship is.  I also look for the tell tale responses that true believers make to evidence of malfunction and to their critics. I look at their increasingly bizarre efforts to maintain their illusions, usually by developing more. The signs are unmistakable. Those often well intentioned but dysfunctional patterns of thinking that result in harm deserve a name. I have called them "culturopathies" or "culturopathic".

In analysing aged care, I look at what people are saying and doing to see what they believe.  In designing a solution, I look to creating a context where all of us can contribute, where many points of view have to be listened to and where criticisms have to be confronted.  I make sure that it has access to all of the information that is available and is close to the real experience being dealt with.  The intention is to ensure that true believers and certainty about what we are doing is confronted and that an element of uncertainty persist in whatever we do so that we are continuously reassessing and reconsidering our actions and respond when they don't work.  We cannot wait another 19 years to find out.  These ideas have been behind my proposal for a Community Aged Care Hub.

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Early thoughts about the Community Aged Care Hub

First attempts to find a solution: In October 2000, a little over 10 years after I first became worried about a US multinational's business practices in health care and started making enquiries, and 4 years after I started the Corporate Medicine website, I wrote a web page based on what I had discovered by then called Lessons for the Future. There is also a link on that page to the academic disciplines and some of the people whose writings influenced my approach to these problems.

Texas Senator Mike Moncrief, who had investigated some of these companies in Texas and whom I met in 1993, helped me by giving me access to the documents from his inquiry. He said that for him it was like peeling an onion. As each layer came off, the more pungent it became.

The web page I wrote in 2000, reflected my thoughts at the time, and my interest in addressing the problems by creating relationships between sectors with incompatible paradigms (patterns of thought). I had by then, stripped off the outer layers of the onion. I wanted to create ethical boundaries between sectors adopting different paradigms, that both sectors recognised and accepted.  Each sector could continue to function effectively.  Each sector would understand the differences in thinking of the other and recognise what was appropriate to each.

Idealistically, I still believed that some sectors could be kept not-for-profit, and did not realise that the corporate lobby and the new market ideology was totally committed to dominating every sector of our lives. I was naive in not fully appreciating the nature of ideology, and its ruthlessness in achieving its objectives.

In the 14 years since I wrote that page, a lot has happened and, as layer after layer came off the onion (I did not realise how many there were), it has become ever more pungent - and the corporate medicine web site grew to over 550 web pages. I would not like to be held to the views I held in 2000, but the underlying analysis has been repeatedly reaffirmed. Much has changed. Hopefully I have gained more insight and a better understanding. Among its other functions, the proposed hub is intended to provide a forum, where some of the general processes I referred to in 2000 are included, and where the ethical barriers between sectors can be negotiated and managed.

Subsequent attempts: In a web page I wrote about the aged care accreditation system in 2006 I wrote:

... It should be obvious by now that I favour the development and exploration of a community driven and focused paradigm within which to cautiously develop a new community system for vulnerable services - one in which people can "realise themselves" and act out their lives in a more diverse and humanitarian manner.

It would capitalise on the skills of people whose qualities and expertise are wasted because they are unsuited to the market paradigm and cannot bring themselves to operate in that way.

The difficulty today is that the community is so engulfed in their commercial lives that they have little time for the development of the sort of civil society where such a civilising system could flourish ..."

+++++++++++++ Later on the same page ++++++++++++

"... The argument then is for a community filter and decision making process based on community involvement, humanitarianism, norms and values mediated by simple common sense in the community.

Regulation, oversight and prosecution provide a background structure embodying and reinforcing principles. We should not minimise their importance in giving form and legitimacy to accepted norms and values governing conduct. When the community embraces these norms and values then they should rest lightly and be seldom used. The letter of the law can be dysfunctional when it rides roughshod over community values and sensibilities.

The response to the failures in aged care, including the failures in process, regulation, oversight and legal constraint has been simply more of the same ..."      

+++++++++++++ And on another page the same year ++++++++++++

"My own view is that whatever system we have, communities should play a pivotal role in running and overseeing the operation of nursing homes in their community. Neither politicians nor market moguls can be trusted to deliver the care the community expects.

The community needs to place itself in a position where it has the muscle to ensure that funding is fair in the light of what the country can afford and what the community is prepared to contribute. It also needs to be in a position where it not only knows but sees what is happening in the local nursing homes so that it can balance funding and care. Organisational structures in the community are needed to accomplish this".

I subsequently discussed how the community could be involved, with groups who were concerned about what has been happening.

In 2009 I made separate submissions to reviews into the Aged Care Complaints Scheme system and the accreditation of aged care homes system. I suggested that complaints handling, regular oversight, and monitoring of accreditation practices be situated in the community. They should be jointly supervised and administered by the community, government and the agency, with defined roles for each. I suggested ways in which this could be done.

... the key to redesigning both accreditation and complaint handling is to place the community at the centre of both processes and give them responsibility ..."

Source: Submission to the Walton Inquiry into the Complaints Scheme - 2009

In a further submission to the Productivity Commission's Inquiry (Caring for Older People) in 2010, I expanded on this and advocated for a community organisation or hub. Medical personnel would be included. This was to be responsible for coordinating and organising all aged care activities and was to act as customer for the services provided. Aged Care Crisis supported my ideas in their submissions.

The government would have been a joint partner in my proposals, providing training, supervision, and acting as mentor for staff working with the community group hub. The accreditation process would have worked with and through this group. There would have been a central national organization drawn from the communities to represent them in negotiations with government.

Current web pages: After the 2013 aged care scandals, I wrote the first three parts of the Solving Aged Care section on the Aged Care Crisis website and positioned them as additional components to Professor Maddock’s proposal for a Community Aged Care Hub and adopted his name for it.

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Theoretical Framework

My analysis of aged care can be seen as broadly situated within, but not constrained by, the constructionist approach to analysis (also called sociology of knowledge). It is a social theory about how we develop knowledge and use it. It has its origins in phenomenology and the theories of social construction first developed by Berger and Luckman in the late 1960s. It is well suited to an analysis of belief/knowledge systems and the relationship between individuals and their cultures in developing and maintaining these. 

I use it to analyse knowledge systems that don't work for mankind and cause harm, how they are created, why they are adopted and are applied in excess, how they are maintained and why they are so resistant to fact and logic. In proposing a solution I have suggested a social structure within which knowledge systems that serve society can be adopted and those that are harmful can be identified and either modified or resisted.

I chanced upon the following description in a recent article by Steven Anthony Quigley which I felt set out these ideas quite well.  I can't pretend that I have read any of the authors he references or the terms used.  The academic development of these ideas, which I became familiar with in the 1970's and applied in my own analyses of events, has progressed considerably since then.

The theoretical framework by which my (Quigley) approach has been formed and influenced is essentially a constructionist approach, which understands meaningful reality as something that can be constructed rather than discovered. As Crotty (2003) puts its, constructionism is:

...the view that all knowledge, and therefore all meaningful reality as such, is contingent upon human practices, being constructed in and out of interaction between human beings and their world, and developed and transmitted within an essentially social context (Crotty, 2003, p 6).

In this respect, I have taken an interpretivist stance and I adopt notions of symbolic interactionism, as cited by Blumer (1969) that:

Human beings act towards things on the basis of the meanings that these things have for them; the meaning of such things is derived from, and arises out of, the social interaction that one has with one‟s fellows; and that these meanings are handled in, and modified through, an interpretive process used by the person in dealing with the things he encounters (Blumer, 1969, p 2).

Finally, I adopt notions of critical inquiry that seek to “ current ideology into question and initiate action, in the name of social justice” (Crotty, 2003, p 157). - - - - .

Beaumont (2009) states that “...self-development is characterized by mature self-awareness, self-insight, openness to experience, open-mindedness, comfort with ambiguity, and cognitive complexity in terms of self and others” - - - - .

Source: Academic Identity: A Modern Perspective by Steven Anthony Quigley  Educate~ Vol. 11, No. 1, 2011, pp. 20-30

Wikipedia has a longer article looking at the development of constructionism.  Because of my personal close involvement with several different cultures with very different views, I became interested in the work of Berger in sociology in the 1970s.  At the same time, I was learning a language and some basic linguistics. I also became superficially acquainted with some philosophy including some of Wittgensteins work on language. Because of my interest in medical education, I studied communication theory.  Constructionism was developing as a theory there too, but that word was I think coined much later.

Social constructionism or the social construction of reality (also social concept) is a theory of knowledge in sociology and communication theory that examines the development of jointly constructed understandings of the world that form the basis for shared assumptions about reality. The theory centers on the notions that human beings rationalize their experience by creating models of the social world and share and reify these models through language

Source: Social constructionism  - Wikipedia

My particular interest has become in patterns of thinking that don't work and are harmful. Often this is because they come from a different context and from a group that does not operate in the context where it is being applied but which imposes its ideas on it anyway.

The proposed hub: The proposed Community Aged Care Hub is an attempt to create integrated social units involving all those directly involved in aged care close to the coal face. Here they can interact and develop ideas that are relevant to what they are encountering in aged care. They should have the power to resist inappropriate ideas and then to promote their understandings of aged care in the wider community.

It is an attempt to create a context which encourages "openness to experience, open-mindedness, comfort with ambiguity, and cognitive complexity in terms of self and others". Within this sort of context it is difficult to get away with oversimplification, selective perception, knowing but not acknowledging, rationalising, compartmentalising, controlling information and the many other strategies used by culturopathies to maintain their legitimacy.

This can be contrasted with the narrow and over-simplistic rigid patterns of thinking that have been imposed by an ideology developed elsewhere that has little to do with actual care.

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Submissions pressing for a community-based system:

Please note: The first four sections of Aged Care Analysis are published and the remaining sections will be made available as soon as possible.

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