Richard Dean Smith, MD

An unabashed and clever critique of received wisdom from academics, politicians and would-be-experts about managed medical care. With pungent wit, Circus skewers the method of ‘reforming’ medical care with the badly needed deflation of the balloon of misguided opinions of ‘self-assumed authorities.’ One can only hope that the body politic will see through the deception. Namby-pamby physicians, spineless administrators, and passive “consumers” have been fair game for the machinations of the insurance industry and academic theorists and pusillanimous politicians.
Hale Tolleth, MD, Department of Plastic Surgery, John Muir / Mt. Diablo Medical Center, Walnut Creek, CA, and former President of the Plastic Surgery Education Foundation.

If you care about the future of American Medical Care, this book is highly recommended. It reveals the scandal of how the HMO concept was sold to the government, insurance plans, employers, hospitals, doctors and the public, without telling the full truth about the inevitable purposeful decrease in patient care. Some chapters are hilarious parodies of the circus of contradictions and the bureaucratic wastefulness of the process. Some are deadly serious about the tragedy for patients and physicians alike, when treatment decisions are made by insurance clerks; when incentives are rigged to deliver less-than-optimal medical care, who benefits? Dr. Smith’s witty and incisive prose style is a pleasure to read. Take my advice, and do so.
Howard Maccabee, PhD, MD, FACR. Assistant Clinical Professor, University of California, San Francisco.

I was delighted to be asked to preview Dr. R.D. Smith’s new book, The Circus of Medicine. Having been in practice for over 20 years, the issues he covers are all too familiar. With parody and tongue-in-cheek humor, he illuminates with rare insight some of the inconsistencies and contradictions in current medical practice in the U.S. An enjoyable read and exploration into the Circus of Medicine.
Mario Curzi, MD. President of Diablo Nephrology Group, Inc., Walnut Creek, CA.

Dr. Smith’s description of the genesis of “managed care” seems painfully accurate. He includes a number of analogies that must make physicians and their patients wonder. We do have a “healthcare system” created by our federal legislature, structured by a federal bureaucracy, and administered by the insurance industry with little regard for physicians and their patients. During the whole process, no one questioned the basic concept. What I find worrisome is the thought that those who did this to all of us now say they will save us from what they have done.
William C. McIvor, MD. Former Chief of Orthopedics, John Muir Hospital, Walnut Creek, CA.


Introduction

Medical practice received uncharacteristic sanction and public approval during the middle decades of the 20th century. For centuries before and decades since, medicine has been the focus of criticism and distrust. Throngs, droves, herds, flocks, legions of self-appointed critics, pricey ‘healthcare’ consultants, economists (academic and otherwise), on-the-run politicians, and promoters of the healthcare insurance industrial complex brought bizarre exaggerated claims against the medical profession. Nearly everyone has opinions on ‘what’s wrong’ with doctors, hospitals, and medicine—a new / old breed of hangers-on surround medicine; such as, some rabble healthcare consultants throwing dice on a blanket in the hospital parking lot, some misguided influential academic healthcare economists dealing three-card monte on the front sidewalk, some less than objective medical journalists hustling a shell game in the hospital foyer, that is, a pervasive new form of healthcare quackery. A result was the managed care mass medical movement.
We must seek another avenue to bring sense to the absurdity of managed care. While medical practice is solemn and serious, humor and satire may neutralize madness of the mass movement of managed care: satire consists: “not of mirth, but of the intense and even painful sense of the absurd.…where it is vice rather than folly that is the target, or folly so noxious as to amount to vice—and provoking reactions that vice engenders but not mere folly—we are in the presence of Satire,” and thus, the modern Circus of Medicine.

Introduction
1. Scheider’s Brew
2. HealthCare Amateurs
3. Medicine in the Gaseous State
4. Free Beer
5. The Lightning-Rod Man, Updated
6. Zeal!
7. It’s Déjà Vu All Over Again, Revisited, Reiterated, Reprised, Rehashed, Recapitulated, Recounted, Reasserted, Restated, Regurgitated, Reechoed, Repetended, Retautologized, Reduxed
8. In the Absence of Absolute Truth
9. Doctour of Physic: His Modern Peer
10. The New Medicine Show
11. All the Wonders of Africa
12. Chronic Pain
13. The Trap
14. Gold’s a Dollar, the Expert’s Free
15. Springtime for a Frog
16. Managed Care: From Miracle to Madness to Myth
17. A Classification of the Unknown
18. Get on Board–The Hindenberg Plan
19. Don’t Look Now, but It’s a ‘Revolution’: Is Quality a ‘Given’?
20. Game Theory and the Managed Care Mass Movement
21. Cabbage Systems International: Annual Report. Eleven O’Clockish 1995ish
22. The Delivery of BeansCare at Konga Beansanente. by Dr. Syckley Moult
23. Dr. Huffahuff’s ManagedBeans Strategy by Dr. Suffin Huffahuff
24. An Old Heart’s Appeal: Her Confession
25. Professor Bray and the Beans of Competition
26. The Celebrated Jumpin Frog of All the County of the Piney Wilderness
27. The U.S. Alti-Thronus Court and the Hobgoblin Decision: Concurring
28. Modern Behavior Economics and the Circus of Medicine
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