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Book reviews

Evidence-based patient choice. Editors Adrian Edwards & Glyn Elwyn
The resourceful patient. JA Muir Gray
Managing Osteoarthritis in Primary Care. Gillian Hosie & John Dickson
 

Evidence-based patient choice. Editors Adrian Edwards & Glyn Elwyn. Oxford University Press, Oxford, 2001. 330 pp. £19.95. ISBN 0-19-2631942


If you think this book will tell you how to implement evidence-based patient choice, then don't buy it. It won't do that, and, if you thought about it for a moment, you would recognise that it never could. There are too many variables before we even get to how we differ as individuals.

No, what this book does is to make you think about the issues that might be important to influence patient choice. Having a cast list that includes the usual suspects gives the book power, and the editors seem to have given them a thoughtful pill before they started writing.

Obviously risk is discussed at some length, and there is a mine of interesting references and perspectives that make one realise that there's more to this than meets the eye. And what about complex issues like the interaction of health economics and patient choice. It's covered, and well. But the most gripping chapter is Angela Coulter's vision of the future, which makes you realise just how much change there is to come. Before the last chapter, evidence-based patient choice could still be an option. After it, there's simply no argument.

The resourceful patient. JA Muir Gray. eRosetta Press, Oxford, 2002. 150 pp. £14.50. ISBN 1-904202-00-4.


Whatever job Muir Gray does, it's the wrong one. He should just be given the task of going around talking to people about healthcare, inspiring us with the knowledge not just that things could or should be better, but that we can help make it so. The use of sharp, often painful, little stories remind us that neither life nor medicine are easy. They also point out that worst impact of the sharpest problems can be ameliorated by good judgement and common sense leavened with some learning and understanding.

The theme of this offering is the contract between doctor and patient. It looks at the history, at what we are doing now, at our perspectives, what's right and what's wrong. And it's not heavy when it does it, so reading it does not weigh us down with a sense of guilt. Rather it helps us see the vision through the fog of everyday problems.

It can be summarised by the new contract between doctors and patients that he espouses. Both patients and doctors know:
Muir Gray is perhaps too gentle with politicians, but it certainly cuts to the chase. And this is a new type of book, and ebook, with associated web site ( www.resourcefulpatient.org ) where you can buy it, or dip in. You can have the best of both worlds: a paper copy to read in bed or on the train, and a look up when you are wired into your computer.

What makes this publication interesting is that it is continually being updated, and updated versions of the website will also appear in print, instantly. There is no large print run, but "print as required". If you order it from the Internet, your book could be printed with 5, or 10, of 15 others. What you get will be the most up-to-date version.

Managing Osteoarthritis in Primary Care. Gillian Hosie & John Dickson. Blackwell Science, Oxford, 2000. 144pp, price not known. ISBN 0-632-05353-4.




Some very clever people have written editorials warning us of the tidal wave of older people with arthritis that is set to engulf us over the next two decades. And it is more than pill-pushing this. Bandolier has already looked at the large amount of untreated chronic pain in the community ( Bandolier 70 ), and lokked at evidence that musculoskeletal problems like arthritis havbe the largest negative impact on quality of life of any chronic disease ( Bandolier 83 ). Put this together with the demographic changes we know about, and it all adds up to a big heap of trouble, most of it landing in the lap of primary care.

This is already a big job in primary care, with up to 20% of GP time taken up with musculoskeletal problems. So managing osteoarthritis in primary care is a useful title for a book. This one is written by GPs for GPs, and that probably makes it unique, and is one reason that it combines the two important qualities of brevity and relevance.

The language is simple and straightforward. The organisation is logical. The diagnrams are super. It is practical, and it uses good evidence. Yet it's not a cook book, but a "tools, not rules" book.

The section on diagnosis, differential diagnosis and mis-diagnosis is just terrific. Can you remember the names and positions of all those hand and wrist bones? Don't worry, there's a simple diagram. Taping the knee? There's a simple diagram. Want to use a "three-pot system" to minimise cost and harm, and maximise efficacy? It is simpley explained.

After two years the book could do with a brush up to include more advice on cox-2 inhibitors and brush up internet addresses, but those are tiny quibbles set against masses of good sense. The important thing about this book is its voice - calm, direct, and sensible. What would be even better would be to see this approach evolve in two ways. First to become an ebook, with an accopmpanying website, and second to expand into other musculoskeletal areas.
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