SURVEILLANCE MÉDICALE

Caring for lesbian and gay people: a clinical guide

authors: Allan Peterkin, Cathy Risdon

University of Toronto Press, 5201 Dufferin St, North York, ON M3H 5T8; telephone (800) 565-9523 or (416) 667-7791; fax (800) 221-9985 or (416) 667-7832

2003/322 pp/$85 (cloth), $40 (paper)

OVERALL RATING Very good
STRENGTHS Comprehensive, well researched, well written; reviews and checklists for easy reference
WEAKNESSES Lack of illustrations; overly inclusive
AUDIENCE Family physicians and other health care providers

In this book, Drs Peterkin and Risdon have prepared a most useful guide for health care practitioners who care for lesbians and gay men. While the intended audience is surely those who specifically work with gays and lesbians, the authors present a well researched and well written text that should prove useful for all practitioners; as the authors quite correctly illustrate, lesbians and gay men are often not “out” to their health care providers, for fear of discrimination. Hence, many practitioners could be providing care to this group without being aware of it. There are many practical tips in this text to assist in providing care in an appropriate and nondiscriminatory manner.

This text is written partially to help address the high levels of dissatisfaction voiced by lesbians and gay men across health disciplines. The authors explore the reasons for this dissatisfaction and provide insight into how it might be ameliorated. They help health care providers to appreciate why this population is often hidden and make useful suggestions about verbal and nonverbal communication that might help patients feel more comfortable.

The chapters each cover areas of particular concern to this patient group. Summaries, checklists, and references, outlined boldly, are useful for review. The book is comprehensive and tackles transsexuality, body jewelry, and substance abuse. The information on body jewelry and substance abuse could prove useful to providers who see patients with such health issues.

One weakness of the book is the absence of illustrations, which might help to simplify or clarify some issues. Some readers might find the text overly inclusive, such as the descriptions of a variety of penile piercings, most of which produce similar health risks.

In Canada’s large cities, clinics and individual providers known to gay and lesbian communities specialize in providing health care to these groups. Practitioners in such settings might feel that, by virtue of their experience, they know how to provide this care and do not need such a book. As one of these providers, I can assure all that this book does provide information and insights that are well worth reviewing.

—Brian Willoughby, MD, CCFP

Dr Willoughby is a family physician in Vancouver, BC, and is a Clinical Associate Professor of Family and Community Medicine at the University of British Columbia.

Guidelines for the management of anemia, 1st ed

authors: Anemia Review Panel

MUMS Guideline Clearinghouse, 790 Bay St, Suite 1150, Toronto, ON MG5 1N8; telephone (416) 597-6867; fax (416) 597-8574; e-mail guidelines@mumshealth.com

2004/78 pp/$20

OVERALL RATING Very good
STRENGTHS Thorough review, fact filled
WEAKNESSES Nothing major
AUDIENCE Primary care physicians

Guidelines for the Management of Anemia by the Anemia Review Panel is a good resource for primary care practitioners. The material is presented in tables with very extensive footnotes. The authors are moderately successful at addressing the complex topic of anemia in a simple format. A useful list of associations and support groups and an up-to-date bibliography are included.

This 78-page book is crammed with facts, some of which will be superfluous for average family physicians (eg, overview of uncommon anemias). There are two main sections—making the diagnosis and managing anemias—and an appendix longer than the two sections combined. These divisions are not crisp, and discussions flow from one section to the next and into the appendix, although page references are provided for continuity. The examination of diagnostic tests for investigation of anemia appears complete and the tests are well discussed. As a laboratory physician, however, I would like to see added algorithms or menus of recommended tests for common anemias.

Common anemias are well classified and well defined, based on mean corpuscular volume and red cell distribution width. The tables in the management section are practical and clear. They guide readers well through stepwise preventive and therapeutic approaches. The anemias are well reviewed under the broad classifications of microcytic, normocytic, and macrocytic.

The extensive appendix revisits clinical presentation and diagnostic criteria. It also includes some fact sheets, a few of which will be useful (eg, patient information about iron).

Overall, I recommend this book as a valuable resource for primary care practitioners. Anemia is relatively common, but its diagnosis might be difficult to establish.

—Dr Victor Prabhakaran, MD, DLO(LOND), FRCPC

Dr Prabhakaran is a laboratory physician, a Medical Leader in the disciplines of Biochemistry and Immunology at the London Health Sciences Centre, and a Professor of Biochemistry and Pathology at the University of Western Ontario.

Women’s health in mid-life. A primary care guide

editor: Jo Ann Rosenfeld

Cambridge University Press, 40 West 20th St, New York, NY 10011-4211 USA; telephone (845) 353-7500; fax (845) 353-4141; website http://www.cambridge.org/us/

2004/374 pp/$55 (US)

OVERALL RATING Very good
STRENGTHS Concise evidence-based discussions of traditional and complementary approaches to a variety of health topics
WEAKNESSES Different authors for each chapter give the book variable quality throughout; it is a relatively short book so not meant for in-depth study of each issue
AUDIENCE Family physicians, other primary care providers, and educated middle-aged women looking for an overview of health issues and the evidence for various treatments

This book discusses the health care needs of a diverse group of women. It acknowledges that health needs are in flux between puberty and the geriatric years. By their very nature these years involve change, and health care needs can be challenging.

What is refreshing about this book is its approach to collaboration between primary care providers and women themselves in assessing health needs and judging the evidence that applies to those needs. It rates complementary approaches with the same critical appraisal as traditional approaches. It puts into practice the principle that women at midlife are a lot more than hormones gone awry.

Chapters on nutrition and exercise offer practical, constructive advice. Chapters on psychosocial and mental health are well written and useful. A chapter on spirituality is surprisingly clear and practical in its approach to what is achievable in an office setting. Half the book is dedicated to disease prevention, with specific evidence-based advice for osteoporosis, coronary artery disease, hypertension, stroke, diabetes mellitus, and various cancers. Where evidence does not exist for screening maneuvers, it makes that clear as well. This book is a good one-stop shop for the latest evidence for those who care for middle-aged women.

—Janet Dollin, MD CM, CCFP, FCFP

Dr Dollin is an Assistant Professor in the Department of Family Medicine and is Director of the Office of Gender and Equity Issues in the Faculty of Medicine at the University of Ottawa in Ontario.

Pediatric orthopedics for primary care physicians

author: Dennis S. Weiner

Cambridge University Press, 40 West 20th St, New York, NY 10011-4211 USA; telephone (845) 353-7500; fax (845) 353-4141; website http://www.cambridge.org/us/

2004/166 pp/$80 (US)

OVERALL RATING Good
STRENGTHS Pen illustrations alongside the x-ray films are helpful in demonstrating various conditions; text reads more like a story than a reference book
WEAKNESSES Somewhat disorganized in presentation; difficult to search for specific topics; narrative approach a deterrent when looking for practical advice
AUDIENCE Family physicians, residents

This is an interesting book about childhood orthopedic problems. It tells the story of development and organizes the various pediatric orthopedic conditions by age rather than by anatomic location. If you are looking to learn about “foot problems,” you need to first consider the age of your patient. Problems are then organized by frequency of occurrence, with more common things first—so once again this adds to the confusion when trying to choose and stay on a topic. But I suspect this was not designed as a reference for one-problem hunting but rather as a story about pediatric orthopedic problems and their most common manifestations, suitable for residents learning everything they ought to know. As such, it is very good. Of note, the last chapter on genetic disorders in orthopedics was enlightening.

—Janet Dollin, MD CM, CCFP, FCFP

Dr Dollin is an Assistant Professor in the Department of Family Medicine and is Director of the Office of Gender and Equity Issues in the Faculty of Medicine at the University of Ottawa in Ontario.

Bulletin Board

What illiterate adults need from you

At many literacy conferences, “experts” with higher education report on what health professionals must do to reach adult learners with limited literacy skills. In a dramatic switch, a conference in Iowa invited adult learners to speak for themselves. The group voted to make the following statement to health professionals:

We need help from doctors now. We need the best explanations about tests, procedures, and prescriptions and their side effects. We want to tell doctors, “We need help to help ourselves and our families. Slow down and take your time. Treat us as you would like to be treated. Simplify your work so that it can be cost-efficient for both patients and doctors. Once you find out we have reading problems, you should follow up. We are human beings [who] need to be understood. Make sure that we understand. It’s about human respect. Yes, we lack a skill. But we’re not less than human.”

Conference delegates generated messages to medical professionals, to educators, and to other adult learners. Their messages to medical professionals, summarized by Maricel G. Santos and Lisa Soricone of the Harvard School of Public Health, were as follows.

• Make instructions readable (use bigger print).

• Make steps clearer.

• Explain “high” versus “low”; give the range of results.

• Make sure a prescription is filled correctly. Tell us when pill colours change. Keep pharmacists informed about prescriptions (especially when medications are changed).

• Write clearly.

• Assess the reading level of prescription labels.

• Explain medication when prescribing: What is it? What is it for? How should it be taken?

• Treat us with respect; don’t be in a hurry and we will treat you with respect.

• Use more picture symbols in instructions.

• Describe possible reactions and side effects to drugs.

• Simplify instructions.

• Do not assume that patients understand and can read instructions; explain or read instructions to them.

• Don’t feel sorry for adult learners.

• Print information in other languages.

Healthy computer habits

The Canadian Physiotherapy Association says several factors contribute to aches and pains from sitting at computers.

• Posture: posture is the most critical component. Slouching puts the spine and limbs in positions that contribute to increased strain and tension, and increases risk of eye strain as well.

• Office set-up: a poorly designed workstation or one that does not fit you well, a keyboard too high or too low, or reaching for a mouse strains the wrists.

• Worker technique: pounding the keyboard, using wrists to move the mouse, or gripping the mouse too tightly strains hands and wrists.

• Work habits: sitting for extended periods without changing position is hard on the whole body.

The Association suggests stretching, moving, varying tasks, and reducing strain in all ways possible. For more tips and information, visit the Canadian Physiotherapy Association’s website at www.physiotherapy.ca.