Family Practice Vol. 17, No. 3, 277
© Oxford University Press 2000
Book Reviews |
Demanding patients? Analysing the use of primary care.
Professor of General Practice, College of Medicine, University of Wales
‘Demanding patients?’ is an eye-catching title which has been prepared by three social scientists for Open University Press. The topic is of core importance to all who work or plan in the primary care sector. ‘Help-seeking behaviour’ is a less emotive phrase that is integrated widely into the world literature on primary health care and highlighted in the 1997 MRC Topic Review on Primary Care as an area of research importance. It is important theoretically and its practical applications are vital to some of the biggest controversies in the world's health services.
The three authors provide a fairly comprehensive analysis of the policy context, influences and approaches to understanding demand and use of services. In Part II, they address lay action in the formulation of demand and, in Part III, they deal with mediating demand in primary care. Extensive references are provided. As a book, it is well written, well reasoned and persuasive, but the perspective is from social science.
Will this book become a text for primary care? Here the reviewer runs into many problems because the authors have not familiarized themselves with much of the relevant literature from primary care and so comments and expectations often are clouded by limited perspectives in the practical arena of care delivery.
The authors do convey a sense of the complexity of the determinants of help seeking both within the Health Service and outside it. This understanding is helpful and accurate. However, discussion of some of the important early literature on help-seeking patterns is omitted and the importance of the general practice ‘gatekeeper’ role in the pre-1990 NHS is addressed inadequately. Pleuralism in primary care delivery since 1990 is discussed, but the impact that this has had on effective gatekeeping to the expensive secondary services is a neglected area in this text. The politician's focus on hospital waiting lists/times has become an important factor influencing UK health care delivery and help-seeking patterns, but the distortions and managerial variances that this has produced are not discussed adequately.
The concept of ‘epidemic distress' caused by medical misinformation is also not considered. Yet the 1990s were characterized by health services becoming politicized with multiple impacts on help-seeking patterns. In the 1970s, the medical profession came under justifiable attack from for the ‘pill for every ill' approach to illness. This was debated widely and the pharmaceutical industry was also encouraged to desist from pharmaceuticalization of minor ailments. Yet in the 1990s, the nation's pharmacies rose to the politicians' call for pleuralism and they are trying to re-establish this market niche. It is unhelpful if academic commentators appear to be uncritical of this change among the entrepreneurs and among many politicians. Despite these criticisms and omissions, I would recommend this text to postgraduate students but I would temper the recommendation by encouraging students to embark on a vigorous search for the missing elements that are vital to understanding help-seeking behaviour in the year 2000. As a piece in the jigsaw, the book is useful, but it is not the authoritative overview I had hoped for.
Notes
A Rogers, K Hassell, G Nicolaas. (270 pages, paperback £16.99, hardback £50.) Open University Press, 1998. ISBN paperback 0-335-20090-7, hardback 0-335-20091-5.
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