Then Why Does It Still Hurt? by Jack Schroder.

The book you have been waiting for: it's not just a recital of HMO horror stories, but a guide to surviving them. In 15 concise chapters you will learn how doctors and hospitals can hurt you; how HMOs and Managed Care contribute to the failure of your medical care delivery system; and how you can avoid injury now and in the future.

Sample Chapter

MY HMO PAYS EVERYTHING WILL MALPRACTICE STILL HAPPEN?

You are in the hospital and they said you would get better soon. If anything, you feel worse. When you went into this noisy white painted place you did not have these other pains, new pains.

You are apprehensive. Your pulse races. Your eyes can't focus on the TV screen high on the wall opposite your bed. Your nose is tied to your bed by a thin greenish tube.

People rush in and out of your room, talking, mumbling, bringing flowers, waking you at all hours. They jab you with needles. They yank your covers off. And no one tells you anything.

In the bed next to you is a stranger who mutters and complains constantly in a strange tongue and turns the TV on to sitcoms you never saw before.

When they bring you food, it is stuff you can't keep down, and even if you could eat the junk, someone grabs the tray away before you can reach for the spoon.

What is wrong?

Nothing. You are in the hospital.

But when you asked the doctor what was happening, he touched his grey moustache and said, "You have to expect to feel a little uncomfortable. That's because you are older, or thinner, or fatter, or whatever."

What about these bruises on your arm? The mottling of your skin? This fear...this horrible dread? Your doctor did not answer any more of your questions. Instead he grunted and looked at his watch. Then he turned his back and strode from the room.

When you asked the nurse why you felt this way, she smiled and said that you ought to talk to your doctor about that, but now she commands, "Betty dear, you have to turn over so I can give you your medication. Here now, over you go."

What medication? No one has told you why they stick these needles into your arm, or your backside. What is this stuff? When did they start calling it medication? Didn't they always call it medicine before?

You struggle to ask her what this stuff is. She smiles and pats your arm as if you are new to kindergarten. "It's something to make you feel better."

That is an answer?

How come you feel worse now?

Have you been injured by your medical care?

Who will help you find out if your medical care has injured you? You can not expect your doctor to tell you that he has injured you because of his inattention. He certainly will not discuss his lack of training, or his lack of experience or skills. He will not tell you about his reliance on uppers and downers. He will not tell you that last night, before your surgery, he was bushed and had three before dinner martinis and didn't remember finishing his meatloaf and green peas. He will not tell you he was pure and simply tired. He will not discuss with you his lack of enthusiasm for medicine or his career or his way of life. How can you expect him to tell you his wife's filing for divorce occupies all his thoughts? He will not tell you he was in trial all yesterday on another malpractice lawsuit and that his insurance carrier has told him he must find another malpractice insurance company.

He may not wish to tell you that your insurance company HMO had told him a new and more complicated policy manual and fee schedule was coming in the mail; or that he must perform an old procedure instead of a newer surgery that will have caused you less trauma. This order came from above because the new method is more expensive. Reducing expenses seems to be the driving force in your 'Health Care' plan, and he is becoming uneasy because the HMO keeps changing its rules.

How can you expect the nurse to tell you about the new nurse's aide who gave you the medicines that had been ordered for the woman in the bed next to yours? Neither will your nurse tell you they are so short staffed that no registered nurse was on duty on your floor all night. Or that the Union had just told the nurses they were going to have to go out on strike Monday because the hospital had decided not to hire replacements for registered nurses who quit or were fired. Instead your hospital is planning to replace two thirds of all nurses with nurses' aides within the next two months in anticipation of the coming merger.

All this because just last week the hospital was bought by a 'Health' Insurance Company back East and so everyone here is jittery and nervous. That may be why the nurses all cluster back there by the hopper room and whisper and glance about as if an executioner is in the next room sharpening his tools.

Your doctor and the nurse may not know they have hurt you. They may not know how what they did or did not do may have injured you. They may not know which of the medicines they gave you caused this injury.

They may believe the treatments they are giving you are helping, not harming you. They may think your pains are just another expression of the illness that sent you to the hospital in the first place. After all, you were sick and that's why you're here.