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August 2003
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Resources Family medicine on the front lines DOCTORS ON THE EDGE. GENERAL PRACTITIONERS, HEALTH AND LEARNING IN THE INNER-CITY
STRENGTHS Outlines concisely how general practitioners work and adapt to changing health care needs WEAKNESSES None AUDIENCE Family physicians and general practitioners Doctors on the Edge chronicles the lives of 25 general practitioners delivering health care to some of the most poverty-stricken inner-city suburbs of the United Kingdom. The book documents the daily struggles and triumphs of dedicated family doctors as they come to grips with the harsh realities of general practice. The book also explores the relationship between family doctors, health care delivery, lifelong learning, evidence-based medicine, racism, and feminism. The book is well written, and the author’s use of introductory phrases from renowned and respected fathers of family medicine give insights into each chapter. The vivid descriptions and real-life occurrences at family practice clinics and patients’ homes almost resemble a film plot, as the author’s narration takes readers from one story line to the next. Most family doctors will be familiar with such occurrences and could relate to most of the stories in this book. I found the book informative in that it focuses on the historical relevance of general practitioners who practise at the edge of the medical profession, at the interface between the scientific claims of mainstream medicine and the patient-centred approach of family medicine. The title of the book suggests crisis but also opportunity. Doctors on the Edge conveys severe difficulty and being pushed to the extreme. The metaphor can also be interpreted as “cutting edge,” however, and can suggest general practitioners use new forms of reflective practice to become more patient-centred. It was interesting to read how general practitioners are experimenting with diverse ways of working and learning about their roles. It was also useful to know how learning about the self, including the patient as a person, is seen as essential to good practice and healthy development. I strongly encourage all family doctors to read this book. This book makes me feel that one day family medicine will take its rightful place as a recognized specialty. —Leonard E. Lockman, MB CHB, M FAM MED(SA), MD, CCFP Dr Lockman practises family medicine at the Dakota Medical Centre in Winnipeg, Man. WHIPLASH AND OTHER USEFUL ILLNESSES
STRENGTHS Thorough, in-depth approach WEAKNESSES Too long AUDIENCE Physicians, health practitioners, lawyers, judges, medical historians This book is a valuable work of social criticism. Whiplash and Other Useful Illnesses follows a lifetime’s observation by Toronto psychiatrist Dr Andrew Malleson. It is a fresh approach to a problem that continues to confront and puzzle family doctors. The book should also interest other health care practitioners, lawyers, and those concerned with health care costs. The author relates learning from his general practitioner mother, who worked in London’s east end during the depression, that patients can put illness “to good use.” From his character-actor father he learned that “people are not always what they seem to be.” Not surprisingly, he emphasizes psychosocial factors in whiplash injury with persisting symptoms, while rejecting many researchers’ underestimation of them. He follows Dr Radanov’s definition of whiplash injury as a musculoligamentous sprain or strain of the neck, and then questions how a sprain can last so long. Most medical students who have limited life experience undergo years of training that emphasize the physical causes of illness before considering the psychosocial ones. Malleson reveals how such an approach fails whiplash patients. He echoes Michael Balint’s classic work The Doctor, His Patient, and the Illness. Too much referral, investigation, and treatment are not only useless, they harm patients. Malleson blames researchers, doctors, chiropractors, lawyers, insurance companies, and patients, pointing out who profits from whiplash. Countries with less “help,” such as Lithuania and Greece, have fewer whiplash cases. The author reports similar patterns in other disorders with strong psychosocial elements. Generally, he protests the increasing creation of illness. Not all readers will appreciate the book’s viewpoint and length. But readers should appreciate its pearls, its thoroughness, and its extensive notes and references. Read it. —Michael Livingston, MD Dr Livingston is a retired family doctor from Vancouver, BC. His continuing research has led to many articles and four books on health care, including one book on whiplash injury. Treating mental disorders in primary care WHO GUIDE TO MENTAL HEALTH IN PRIMARY CARE
STRENGTHS Well organized and focused WEAKNESSES Limited and simplistic; very clearly aimed at the United Kingdom AUDIENCE Primary care practitioners in the United Kingdom This guide is a most interesting project. Developed by the World Health Organization and adapted for the United Kingdom,* it feels awkward in this North American’s hands. The guide lists the most prevalent mental disorders in primary care and then describes typical presenting complaints, diagnostic features based on the ICD-10, and differential diagnoses and references to appropriate chapters. This is followed by essential information for patients and families and handouts for most of the conditions listed. Treatments are briefly described, including medication where appropriate. Each section concludes with indications for referral. Included with the book are three 1/2-inch diskettes with questionnaires and patient information. These can be used to assist in diagnosis and management. The information on specific disorders is clear and straightforward but perhaps a bit simplistic for practising general practitioners in Canada. The context is jarring at times, as a fair bit of space is given to resources that would be hard to access from “the other side of the pond.” These would include the UK Register of Councillors and Anon Family Groups UK and Eire, for example. What I like about the book is the strong sense of collaboration among those serving this difficult patient population and the care and respect given those same patients. Topics are laid out in a logical and accessible manner for students who need essentials fast. The book seems to be aimed more at residents or students than practising primary care physicians. —Carl Wiebe, MD, CCFP Dr Wiebe, a former rural general practitioner, is an Assistant Professor in the Department of Family Practice at the University of British Columbia in Vancouver. *The WHO Guide to Mental Health in Primary Care has been adapted for Canadian physicians and is available from Dr F. Baudouin, General Project Director of the WHO Educational Package Implementation Project, telephone (613) 237-9993; e-mail baudouin@attglobal.net |
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www.cfpc.ca
Peer reviewed
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MEDLINE |
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| © 1996-2006 | The College of Family Physicians of Canada • Subscription rates |
Author:
Linden West
Author:
Andrew Malleson
Editors:
WHO Collaborating Centre for Mental Health Research & Training, Institute
of Psychiatry, London