Family Practice Vol. 17, No. 3, 278
© Oxford University Press 2000
Book Reviews |
Primary care management: cases and discussion.
Lecturer in General Practice, General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge
Primary care practitioners know that, unlike many textbooks, their patients' problems are seldom organized into discrete medical systems and that the context of patients' lives and experience contributes importantly to making diagnoses and, especially, planning management.
This book, described appropriately by its author as a workbook, takes 15 primary care clinical situations and invites the reader to work through them in a way that acknowledges this reality of practice. Each clinical situation begins with a vignette, giving background information about a patient as might be known to their doctor. The vignette then brings the patient to the doctor with a problem and asks the reader to discuss and answer related questions, which change as the clinical situation evolves. Each set of questions is followed by a discussion, which cites published evidence for its assertions.
The book aims to teach the construction of primary care diagnosis and management in biopsychosocial terms, either for groups of learners or for individuals working alone. Through its chosen clinical situations and questions, it generally succeeds in this, though where the vignettes give an account of consultations, it might have made more explicit the process of enquiring into patients' views about proposed treatment. This is an area of the consultation where it is easy for doctors to slip towards one-sided planning without proper negotiation with patients.
Although there is no intention to offer advice about a comprehensive list of common scenarios, those chosen are familiar, relevant and worthwhile, ranging from involuntary weight loss, hyperlipidaemia and the menopause, to give three examples. The book's use of published evidence to support its discussion of possible answers to the questions it poses is welcome although, without information about the author's literature search strategy and with the inevitable omission of very recent important research, sceptics will continue to have grounds for discussion—which is, perhaps, no bad thing.
Written from an American perspective, the book's approach nevertheless engenders a remarkably generic feel. Some of its suggestions, however, transfer internationally with some difficulty—the pressure on services such as psychotherapy or dietetics, for example, may mitigate against their involvement at quite such an early stage as the author indicates.
These criticisms are minor and do not detract from a text which, overall, takes a helpful approach to the difficult matter of learning to practise primary care with evidence, epidemiology and individuals simultaneously in sight. There is a current interest in the capacity of narrative to contribute to education and research. This readable, useful book located in the everyday business of primary care is in tune with that approach.
Notes
Goutham Rao. (262 pages, $29.95.) Sage Publications Ltd, 1999. ISBN 0-7619-1206-3.
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