Counsellors and Mental Health Professionals talk

June 19, 2016

Our MCA blog Editor, Margaret Penhall-Jones gave a talk to the Mental Health Professionals’ Network, Coffs Harbour Collaborative Network and Counselling Services, Inc. 16 June on

The Complexes:

a Jungian Perspective and the Association Experiment

Margaret practiced in Sydney as a counsellor and psychotherapist for a decade before moving to Coffs Harbour in 2014. She currently applies many of the theories and skills from that earlier career to her current activities as a writer ( ) and developer of local and online courses on writing skills ( Her current Australian romance novel is Keeping his enemy close and she has a personal blog at

As Margaret described it in her earlier book: “A complex, for Jung, is a response to situations in the world, which we developed at a time when we had little control over our world or our reaction to it. When similar situations recur, the complex response seems to take over our psyche and we feel compelled by it. The response occurs on all levels, including ideas, feelings and physical sensations. … Complexes related to parents, ‘father’ and ‘mother’ complexes are particularly tenacious. Much psychotherapy is devoted to untangling these complexes and allowing adult individuals to interact with their world without undue influence from their parents.” (Dreampower, 2008 p.49)

The MHPN and Counselling Services, Inc. are non-profit organisations and Margaret freely donated her time to give and prepare the talk.


Open Forum Series: Evidence-based Mental Health

September 1, 2015

Mental Health Professionals’ Network, Coffs Harbour Collaborative network

Title: Open Forum Series: Evidence-based Mental Health

For Registration go to


Coordinator:           Dr Tom Benjamin with Audio/visual material obtained with permission.

Topic:                         The Evidence-Basis in Mental Health Services

Mental Health has in the past decade become an important economic and national defence issue for the Western World. Some authorities regard Medicine in itself to be among the leading causes of death in the Western World. There has been a massive increase in the number of people classified as mentally ill, excused from the workforce and sometimes starting from childhood a lifetime of dependency. This series draws together viewpoints from authoritative international sources. The Forum is open to the general public as these are issues that extend well beyond the Health sector. They must be addressed in the political and economic spheres so require an informed public.

Dr Benjamin will present Audio/Visual triggers for discussion, with templates and guidelines to evaluate the issues from the perspectives of the scientific method and its clinical, economic, sociological and historical variants. The non-profit Coffs Harbour based Counselling Services Inc has established this community meeting venue and has kindly offered to merge their group sessions and those of the local branch of APS to promote these MHPN meetings.

Topics for future meetings –members of MHPN and participants are urged to mention their areas of further interest within this evidence-based model.

Follow Up – As a part of his multimedia activities, Dr Benjamin has launched a series of free online on Forensic Psychology, Neuropsychotherapy and Neuropsychology. Such audiovisual Professional Development material will be part of the follow-up for this Evidence-Based Series.


National Psychology Week

November 6, 2014

9th November is the start of Australian National Psychology Week. Free events are available at locations around the nation.

In addition to the many live events a free n online course is being offered through on Neuropsychology. Although it is targetted at registered and practising forensic psychologists it is open to the general public. The international firm, Accredible, is making a special offer of its portfolio services to mental health workers wishing to document their participation as self-study professional development.

This course is at the cutting edge of the genre of Massive Open Online Courses (MOOCs), employing recent technologies such as avatars and multitracking to allow cheaper, quicker production and customisation. So it has a general interest beyond the content for teachers and scientists from other disciplines.

The topic itself should be of interest to medical consumers as head injury is a common court and insurance claim so the methods of assessing such claims need to be widely understood for transparency and accountability.

The initial podcast version of the full course is at and course descriptions at

MCA 2014 Annual General Meeting

July 18, 2014

The MCA 2014 Annual General Meeting will be held Sunday 20th July in Sydney CBD. To facilitate out-of-hours entrance, members and guests will rendezvous at 1 PM at Circular Quay at the entrance to Rossini’s Restaurant.

Annual Report For The Year Ended June 30th 2014 is as follows:

Medical Consumers Association Incorporated

Reg No : INC1171602

Committee: Committee members at the date of this report are as follows:

  • Laura Leonoff President
  • Peter Andrew, Dr Tom Benjamin Joint Vice Presidents
  • Andrew Allan Secretary/Treasurer

PRINCIPAL ACTIVITIES : The continuing activities of the Association are as a consumer association assisting medical consumers and representing their views via submissions and committee representation to government and government agencies.

Activity Summary for the period July 2013 – June 2014

Once again a limited amount of donated time-limited representation on external committees to that of attendance at the Health Policy Advice Group series held at NCOSS. Joint meetings were again held with FLAC and some minor advice and letter writing in support of cases was carried out. A response to a recent item in the SMH by journalist Nicole Hasham about the HCCC not investigating cases was made but to date no response has been received. A copy was sent to MEAG who have responded. A meeting about this with MEAG may be possible in the new FY.

The new website/ blog set up by Dr Tom Benjamin that uses WordPress content management technology made possible rapid additions to cover current interest topics items. As the new blog has allowed updated material to be presented running costs have been kept low and in any case limited time available did not allow for publication of any editions of the MCA newsletter as a result no need existed for more funding and so it was decided to extend all existing membership subscriptions paid to cover an additional year.

Letters have been written to several MPs, the NSW HCCC, and the NSW Attorney General’s departments on behalf of members. It has thus been established that the NSW Attorney General will not inquire into alleged misconduct within the courts advice being that ICAC is the body that should be approached. Work is currently underway to do this. Submissions by MCA were made to the Australian Productivity Commission’s ‘Access to Justice‘ project and also to an inquiry held by the Parliamentary Committee to the NSW HCCC called ‘The Promotion of False or Misleading Health-Related Information or Practices’ . Both submissions can be be viewed on the respective websites of these two government bodies.

ACCOUNTS for the financial year July 2013- June 2014are available for the AGM. This report is made in accordance with a resolution of the MCA Committee and is signed for and on behalf of the Committee

 A Allan Secretary Dated: 10 July 2014

Promotion of False or Misleading Health-Related Information or Practices Inquiry

January 31, 2014

Complaints management HCCC style: Did consumers ever ask for this?

 A Special Edition of Medi-tation was prepared to urgently ask for views about an  inquiry initiated by the Parliamentary Committee to the Health Care Complaints Commission called “The Promotion of False or Misleading Health-Related Information or Practices (Inquiry)”. Submissions close on 7 February 2014 which left little time to make further submission.

 We are also very interested to know of any contact (positive or negative)  that you or others may have had with the HCCC but do realise this may be difficult because of  laws that stop information about HCCC cases being made public.

 Is NSW Parliament seeking new powers for its HCCC that could lead to prosecution of medical consumers?

MCA’s reasons for concern about this inquiry are the way community input was made difficult and the total absence of an explanation as to why such powers might be needed.

 The wording of the Terms of Reference are “That the Committee on the Health Care Complaints Commission inquire into and report on possible measures to address the promotion of unscientific health-related information or practices which may be detrimental to individual or public health. The Inquiry will focus on individuals who are not recognised health practitioners, and organisations that are not recognised health service providers. … The publication and/or dissemination of information that encourages individuals or the public to unsafely refuse preventative health measures, medical treatments, or cures.”

 Chair of the Committee, Mrs Leslie Williams advised in response to some community  concerns raised about the possible direction of the Inquiry: “This Inquiry is not focussed on the alternative health remedies which many Australians have adopted as part of responsible supplementary health care. Nor will it inquire into the many legitimate discussions and studies taking place within the science and medical community about appropriate health treatments, along with the diversity of health options available.”

 This ambiguous combination of focus and assurances make it difficult to work out who might be targeted and who might be exempted. If “alternative health remedies” and the “science and medical community” are exempted – who does this leave as the villains?

 Such wording could easily embrace medical consumers. They might be the ones warning that something isn’t working or is dangerous. Indeed, it is ironic but not uncommon for medical service providers to themselves be medical patients from time to time and practitioners are often the most highly critical of their own colleagues.

 How little has improved was highlighted in recent media reports and their aftermath:

 Australians are large users of Statins (HMG-CoA reductase inhibitors) to lower cholesterol levels. Two ABC Catalyst programs suggested this was a problem. The ABC and the individual journalists and their interviewees came under massive attack from doctors. New HCCC powers might deter the ABC from future investigations of such medical issues if they had the onus of proof to show that they were “legitimate discussions and studies taking place within the science and medical community.”

 On 10 June 2013 Channel Nine A Current Affair (ACA) aired that a hospital doctor reported a senior surgeon to regulatory authorities. The result was that the hospital doctor lost his job and had to move to another State to find employment. The senior surgeon, who held an Order of Australia, continued to operate for another 6 years before retiring with full benefits. An unemployed whistleblower doctor might find that they had now lost any protection once they ceased membership of the “science and medical community”

 How does the HCC Act actually work and why ?

MCA was part of the original Consumer Advisory Committee (CAC) to the former Complaints Unit of the NSW Department of Health. A 1989 Phillips Fox report  (JHM80170/06.02.89/MK) had explained what was wrong with the Complaints Unit system within NSW Health. This Complaints Unit reported directly to the Health Minister, at that time, The Hon Peter Collins. He explained to MCA how he found the Unit very useful because he could use it as a microscope to look inside his Department without going via the Director General. But Phillips Fox had found the problem was that the Unit was “… fundamentally an investigation and prosecution body” and also that “The problem with the Complaints Unit is that it is not a conciliation body”  By the early 1990’s in the battle over the HCC bill the new Health Minister was said in media coverage to view MCA and CVAG, who were opposed to the bill, as ‘fringe discontents’ and used Government-financed groups to support the passage of the bill by forming what they called a Consensus Group which opposed the views put forward by MCA and CVAG .

 The crunch came over a restricted Hansard proof edition that was the first public mention of the setting up of a Complaints Commission (the other being a telephone directory listing for the Commission that had not yet even been created by vote!). The expectation by NSW Health’s Complaints Unit was that CAC members must not talk to outsiders about this proposed Commission. MCA was unable to fall into line over this. The reason presented for secrecy was that if certain medical industry groups found out the details they would put pressure on government to get changes made, to the detriment of all patients. In addition it was claimed by the director of the Complaints Unit that the form of complaints management for the new HCCC had been well researched and indeed told the ABCs Andrew Olle radio show that the US Government Accounting Office (GAO) had been so impressed with the proposal that the GAO was going to recommend that same type of service should be considered for the entire USA.

 MCA decided to talk to outsiders in order to find out more and the minutes of the CAC show that as a result MCA got censured by all the other members of the CAC for this. Subsequently MCA failed to get invited onto the consumer representation committee that soon replaced the CAC.

 What we found out by not keeping quiet was that the AMA had been involved from the start in defining the shape of the proposed HCCC and that the medical industry knew all about it before medical consumers ever knew of a proposed commission. Hansard was, after all, a mere transcript of a public Parliamentary debate, so the strategy had clearly been that lay community representatives would be flattered and gullible enough to not realize this and presume they were privy to some grand ‘secret’.

 MCA contacted the Director of the GAO in the USA by phone to be told that GAO indeed had reviewed the proposed complaints system by NSW Health but far from being impressed said that their own USA system was a ‘mess’ but that none of the others they’d seen were any improvement. Further, such a complaints system could not be used in the USA as it could breach US human rights and consumer protection standards. The GAO Director scoffed at the denigration of the ‘bad apple’ approach saying that their studies showed a high proportion of complaints commonly came from a very few practitioners.

 It was such considerations that led to MCA solidly oppose the establishment of the HCCC and also locally MCA was advised by Gibsons Solicitors that the HCC bill if passed into law would bring into being clear legal disadvantage for medical consumers. The Slattery Royal Commission had not recommended this bureaucratic solution but, rather, a streamlined Supreme Court system to facilitate negligence/professional misconduct lawsuits.  

 By that time the NSW Parliament was split down the middle with a small group of independent MPs holding the balance of power. This made it possible for lay voices such MCA’s to be heard at least a little bit. Such conditions plus a lot of time being donated by MCA members in lobbying MPs did result in two minor changes being made to the original HCC bill, but the bill still passed into law by just one vote. We thus did get the lifetime appointment of a Commissioner reduced to a 4 year term, and also got a parliamentary committee to provide oversight. However this latter amendment was in effect totally nullified by the condition that this parliamentary committee could not inquire into individual complaints. In later years MCA has given sworn evidence to parliament about the problems for consumers the HCC Act produces but, with a return to large majorities since then and thus a return to executive government, MCA’s efforts had no effect.

Some things to consider

This current inquiry was started by government, not because of any stated consumer complaint. 

Australians have no clear constitutional  civil or human rights so the HCCC can have almost any new powers added.  Hilary Charlesworth in “The Australian Reluctance about Rights” Osgoode Hall Law Journal Vol31 No.1 1993 p195 explains that protection of rights is not provided for by the Australian common law or legislation. 

 Does the HCCC focus on conciliation actually work for victims?  Jack Schroder in his 1990 book Identifying Medical Malpractice wrote: “Plaintiff verdicts in medical malpractice cases are the principal impetus to change and improvement in the medical care delivery system. Plaintiff verdicts have done more to improve medical care, to correct abuses in hospitals, and to stop adverse drug effects, than any other force in this country. Where social pressures fail, money does not.” 

 Who decides what is scientific and what is not, and how? Ray Moynihan’s 1998 book Too Much Medicine ISBN 0 7333 0652 7 claimed many mainstream medical treatments “have never been rigorously scientifically tested and that even those that have been proven are often widely overused – on people who may not need them.”  There have been even stronger critiques of the medical growth area of psychiatry from within its own ranks.

Summary of Reform Issues

September 10, 2013

The MCA has been actively following up what have been touted as reforms following the decade of revelations about the NSW health system in the latter decades of the 20th Century.  Because most of these bureaucratic and legislative changes were wrought supposedly in the consumer name they are often taken at face value as supposed reforms in the public interest,

It is appropriate for MCA to assist researchers in getting the facts right. We want to ensure that researchers check the actual versus claimed histories which are often merely based on unsupported interview anecdotes from supposed ‘authorities’. The big pitfall for those new to the field is that they are often unaware that these same authorities were often at the time investigatees rather than investigators. They are thus allowed to re-write history. The archives that would show perspective are often locked away. 

Issues that should be considered in any such review of reforms should include:

  1. Counter-productive over-regulation – Some of the reforms such as the Psychologists’ Registration Acts were brought in as supposed ‘protective’ legislation but without there having been any consumer consultation about the implications. Cost increases following onerous registration requirements such as supervision and professional development are important considerations. These should have been subjected to the scrutiny of trade practices legislation. It was only through the actions of MCA members that the NSW Ombudsman, for example, reviewed the Psychologists Registration Act and found it to be a rubber stamp – a very expensive rubber stamp. These issues need to be reviewed properly.
  2. Executive usurpation of judicial functions – The Royal Commission into Mental Health Services had actually recommended a professional conduct division of the Supreme Court as a solution rather than executive branch investigative bodies, noting the inadequacies of codes of conduct and the like in preventing problems. Former Premiere Neville Wran had predicted that proliferating investigative bureaucracies would ‘disappear up their own fundamental orifice investigating each other’. There have been countless such warnings yet we have had more of these bodies imposed in the supposed name of consumer protection, when many warnings had cited litigation as the best consumer protection.
  3. Regulation and legalization of science – Psychology was a science like physics, chemistry, economics and anthropology, to name a few, that did not require government registration. For decades the NSW Health Department and Australian Psychological Society had opposed registration of psychology as unnecessary. The clinical psychologists finally convinced the states and federal government to register psychologists with a steep increase in professional costs, all of which will be passed on to consumers through fees, taxes, and changes to practices. None of this had been discussed with consumers. Although there had been an advertised discussion period, only interested professional parties had heard of it and responded. No consumer groups contacted by MCA had known anything about the changes, much less the potential cost implications.
  4. Psychiatric labelling – this had been exposed in the Royal Commission as a way of covering up deaths from medical negligence. Patients had been given bogus psychiatric diagnoses and their deaths due to inadequate basic medical care, such as mis-management of pneumonia, had been written off in false death certificates. These issues were never fully exposed and the legacy continues. There have been warnings issued such as by Allen J Frances about the dangers of expanded psychiatric labelling and their potential for misuse. MCA is concerned about the way this labelling has been creeping into mainstream medicine, particularly in the diagnosis of conditions that have a pain component or injuries injuries resulting from abuse.

The above issues together affect millions of people worldwide. Books have been written warning about them. MCA seeks to ensure that the public maintains vigilance and does not assume any of these have been resolved through ‘reform’, let alone that consumers had been given any valid say.

A Near Miss?

July 26, 2013

A recent case in the NSW Supreme Court and Court of Appeal raised many issues relevant to consumers, practitioners, and the economy in general:

Varipatis v Almario [2013] NSWCA 76

When reported in the Sydney Morning Herald in February the President of  Doctor’s Action said the Supreme Court ruling would place an intolerable burden on the family doctor. “This will force doctors to refer patients off for every test under the sun or fear being dragged into the courtroom. The cost to the health service will be astronomical ..”

The Appeal in the NSW Court of Appeal overturned the judgment:

Excerpts from the case follow:

“ …. The plaintiff was morbidly obese at all relevant times. He had numerous health problems, including elevated liver function test results, and needed to reduce his weight before cirrhosis set in. As a result of failing to lose weight he developed cirrhosis in June 2001 and subsequently liver cancer, which is expected to be fatal. The plaintiff argued that the appellant failed to take the steps that, at the time, a reasonable general practitioner would have taken to treat his morbid obesity, and thus prevent his liver cancer.

The [Supreme Court] trial judge found that the appellant breached his duty of care to the plaintiff in the following three respects: 1. failing to refer the plaintiff to a bariatric surgeon by 30 July 1998; 2. alternately, failing to refer the plaintiff to an obesity clinic or endocrinologist; and 3. failing to refer the plaintiff to a hepatologist by the end of September 2000.  However, the trial judge found that only the first breach identified was causally effective. ..”

The NSW Court of Appeal found that:

“A general practitioner may be obliged, in taking reasonable care for the health of a patient, to advise that weight loss is necessary to protect his or her health, to discuss the means by which that may be achieved and to offer (and encourage acceptance of) appropriate referrals. The expert evidence of the general practitioners did not demonstrate any obligation, or even power, to do more than that:

 … The duty of care stopped short of requiring an exercise in futility. “

The case raised the common question of how much follow up is “reasonable”. Health services do not and legally can not invade privacy by constantly ringing up everyone who has passed through their doors, much less police them over taking medications and following up referrals. So where do the boundaries of “duty of care” lie?

Clearly in some cases the follow up is an intrinsic part of the treatment. The patient may be sent home rather than remaining in a hospital bed but they are still under treatment. In other cases the patient is left with some decisions to make. In the Almario case only his decisions and actions could ensure weight loss. Medicine as yet has no passive solution to the problem of overweight. The Supreme Court had regarded surgery as a solution but the Appeal found that “Although bariatric surgery was undoubtedly available in the years 1997 to 2001 in Sydney, it was not necessarily successful or the benefits long-lasting, nor was it without complications.”

This raises all sorts of issues. Practitioners may hold different views on the benefits of a supposed ‘treatment’. For example, what if a psychologist or psychiatrist did not send a patient for ‘Rapid Eye Movement Desensitization And Reprocessing Therapy, or conversely, did send a patient for ‘Rapid Eye Movement Desensitization And Reprocessing Therapy’?

Could a patient sue for either? Would the psychologist or psychiatrist be liable if they did not follow up the patient each day to make sure they were following their treatment regime?

Protections come at a cost.  The Westminster system of parliamentary government separates the powers of the legislative and judicial arms of Government.  This means consumer interests are often first identified by lawyers in an adversarial system on a case by case basis.  However, the two arms of Government do influence each other, and the fallout from unwise judicial decisions can be onerous ‘protective’ legislation which has unforseen impacts.  It is entirely possible that if this case had not been successfully appealed, doctors and consumers would have seen the principles enshrined in legislation in this, one of the most highly-legislated States on the planet.

The consumer voice needs to become much more broadly informed before supposed protective measures become entrenched and by our silence ‘endorsed’. As the Doctor’s Action group pointed out there could be ‘astronomical’ costs associated with protections as extensive as those proposed in the first hearing of the above case. Where there are high costs, someone ends up with the bill and someone else may lose a service that is cut to pay for it.

Onerous provisions can put practitioners out of work. When they vote with their feet consumers never hear their opinion – the nurse or psychologist who resigns quietly goes into another career. We don’t hear them on the morning talk shows.

MCA is concerned to ensure that the ‘squeaky wheel’ is not all that is ever heard. The Health Sector has a big impact on the economy as a whole and changes resulting from courts and legislation play a major role.

Nobel Prize winning economist Milton Friedman pointed out that

“The great danger to the consumer is the monopoly — whether private or governmental. (The) most effective protection is free competition at home and free trade throughout the world. The consumer is protected from being exploited by one seller by the existence of another seller from whom he can buy and who is eager to sell to him. Alternative sources of supply protect the consumer far more effectively….”

Onerous provisions can have the impact of restricting practice. Certainly we have seen many instances of prestigious practitioners exposed as dangerous. But it was only through competing practitioners that the dangerous practices were ever exposed. Consumers are commonly the last to know that their treatments were wrong.

One important role for the consumer voice is helping to define the ‘limits to protection’.

Mental Illness Collateral Damage

July 13, 2013

It is very rare in science that a practitioner comes out of retirement to warn against the dangers of his own career findings. Dr Allen J Frances has done just that. He went public with warnings about the dangers of overdiagnosis of psychiatric disorders.

The MCA supports consumers of any type of medical condition, whether physical or psychological. However, these groups do not always have congruent interests. Policies which help one type of consumer can damage another. MCAs role is not to take sides on this but to make sure the issues are public and that ‘silent majority’ voices are not buried by the voices of providers and sufferers with current pressing issues. In other words, a former cancer patient in remission may not be out campaigning about their condition while someone with a current or recent brush with a mental illness may want to get the public ear.

Mental illnesses were traditionally somewhat separate from other illness categories. They were treated in different hospitals and by different specialists. In the 20th Century these boundaries blurred. There began a big push to ‘normalise’ mental illness to give it greater acceptance.

While this may have been of some benefit to those with traditional mental illnesses, it had consequences for other illness categories. By making mental illness seem more common it became easier to attach a ‘mental illness’ diagnosis to anyone making a claim for injury. ‘Behavioural’ factors were introduced into any condition involving pain. In other words, as soon as one felt pain in a dental chair or made an insurance claim there was a chance of having some sort of psychological condition inferred and written into the medical record.

There had long been abuses of this in totalitarian regimes, applying mental illness labels to dissidents. But by the end of the 20th Century such diagnosis in the West had become so cavalier that headlines often read ‘50% of people mentally ill’.

This propaganda made if far easier to attach the label to an opponent in a court case. Any scrap of evidence from the person’s history could be dredged up as supposed ‘evidence’ that they had ‘a pre-injury mental illness’ which could then be used to defeat their current injury claim. MCA is familiar with such malpractices and the abuse of the necessary protections afforded to expert court witnesses.

MCA will be posting more on this issue. As Dr Frances has pointed out it affects millions of people, most of whom aren’t even aware that these issues might affect them one day.

Of most concern is the danger that the mental illness label might be applied to anyone challenging the medical system. This was the reason for MCAs decades-long focus on the Chelmsford saga in NSW. The issue was portrayed as a problem of ‘how we treat our mentally ill’ when the history clearly showed that these victims did not have mental illnesses. Their initial complaints were about mainstream medicine gone wrong. The mental illness label was then attached to shut them up. A patient dying of pneumonia from pressure sores caused by dodgy medical experiments and inadequate nursing resources would have the death certificate falsified as ‘heart failure’ with the implication of a pre-existing anxiety condition.

The lessons from this saga have not been learned. They have implications for all medical consumers. The propaganda linking all this to ‘mental illness’ has succeeded in deflecting scrutiny of the systems that allowed these tragedies to unfold. The so-called ‘reforms’ that have been brought in need a thorough and objective review. They cost many millions of dollars and may in some cases be making consumers more vulnerable than before. MCA has made many parliamentary submissions on this which are available for download.

Medical Consumers Association Inc., Australia

November 13, 2009

Welcome to the MCA blog. Medical consumers are potentially one of the largest constituencies in the world -ie- nearly everyone sees a doctor, dentist or at least purchases some sort of remedy. Even doctors don’t treat themselves – indeed, they run greater risks than the rest of us as all the special attention they get in hospital brings more risk of infection!  Medical error is likely to become the leading classified cause of death in the developed world once cancer and heart disease are reduced.

Why hasn’t this gigantic constituency (billions of people) ever achieved any political prominence? Easy. Most people at a given moment aren’t sick. Nor do they know which illness they might contract next. When their illness is past they seldom band together in organisations or lobby groups – they’re usually just happy to put it behind them. The net result is that the voice of the vast majority is never heard.

Nor do most have much to say. Consumers don’t always know whether they’ve been given the best treatment. Sometimes they’ve been unconscious the whole time so they’d be the last to know. The body does much of the healing and may compensate for the error.  So if there have been problems it will often only be the treatment team that knows that anything went wrong.