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Book Reviews

Advancing Clinical Governance. Edited by Myriam Lugon and Jonathan Secker-Walker. Royal Society of Medicine Press, 2001. ISBN 1 95315 471 7. pp 213 £18.50.

Quality control (for that's what clinical governance is, but using some form of newspeak to make it sound sexy) is always a shock to organisations when first introduced. Organisations all react in exactly the same way, a mixture of rage and denial (from the majority), excitement (from a few), or cool calculations with an eye to the main chance (a tiny few).

Lesson number one is don't get angry, and lesson number two is don't get excited. The Mr Angrys will just waste their time, and dissipate energies better spent at something else, and preferably getting to grips with this new quality agenda and figuring out how to use it best for themselves, their team, and their customers. Mrs Excited will waste away waiting for something to happen today, but it never will. It will always happen tomorrow, or that's how it often looks.

Look forward and progress is glacial. Look back, and it is frantic. The simple lesson is that quality control (or clinical governance) is too important for any of us to dismiss it. If we want to have an existence that is in any way congenial, we have to be prepared to be active participants. Zealots rarely make good governors, and all that is required for the zealots to take over is for good folk to do nothing because they think it will bring them a quiet life. It won't.

We all have to get a grip on quality control. Start by finding out as much as you can about what other people have written, especially those who have devoted some thought to it. A good start would be to read this book. It won't answer all questions, and there will be some bits you (more or less) know already. But there is wisdom, and there is an astringent quality to some of the chapters. That on the "myth of accurate clinical information" has real bite. Stacks of contacts and sources are also given. Read this and you won't be caught out in this brave new world.
Official Health Statistics - An Unofficial Guide. Edited by Susan Kerrison and Alison Macfarlane. Arnold, London, 2000. ISBN 0 340 73132 X (pb). pp290 £16.99.

This isn't a list of tables saying how many people have what diseases, but a primer on how information relating to health and health services are collected, and sometimes on how they are used, and often why they are different.

How many people in the UK are in paid employment? Well, it depends on which of three different information collecting systems we use or believe. The maximum difference is one or two million people in 23 million or so. The book goes into some detail about the differences, and why they occur and how real they are. So, after a few pages, the reader is an informed reader.

And that's how it goes. From, topically, the census, through notification of diseases, health inequality, money, occupation, environment, the NHS and social services. Each chapter is a little jewel, coming with boxes for sources on paper and electronic. For just about each of the chapters there is a discussion about how the information is collected, and what it means. This is important, because there's absolutely no point having a heated discussion about health inequality, for instance, if we have no idea of the relevance or veracity of the "fact" we are discussing.

Not a light read perhaps, but an illuminating one, and to some of us a fun one. It will make you think about the "evidence" often trotted out about health statistics. It will make for more informed decisions.

Now it's off to the census to decide how much truth to tell!

Critical appraisal of the medical literature. David Marchevsky. Kluwer Academic/Plenum Publishers, New York, 2000. ISBN 0 306 46474 8. pp 304 £55.25.
This is at the same time an interesting and a curious book. It is written by a psychiatrist for, for example, psychiatrists preparing for a paper of MRCPsych examinations. In the introduction it claims to want to reach a general audience with little or no background of systematic critical appraisal.

Make no mistake about it, everything you might want to know is in this book. It is logically ordered, it is thorough, it is detailed. But, by golly, it is a bit of a tough read. Open it at random and one is into details of chi-square testing, the z-statistic, and multiple prediction.
All the usual critical appraisal stuff seems to be there, and there is quite a nice description of bias. The way in which statistical significance versus validity versus importance versus usefulness is described is resonant of some of the most sensible of ways of looking at data. But it's all very sparing in the use of words and examples, and you really want to have to know the answer to keep digging.

It is a fantastic top-shelf book. When you want to know something, you know where you will find it - in here. But the style and price both militate against carrying it in your pocket for light relief. It is also curiously mis-titled (without any suggestions for a better one, though).
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