Within their field, the ''practices'' they seek to shed light on are largely those which relate to patient-doctor interaction, mainly in the setting of the individual consultation. Some aspects of ''practice'' are not covered, e.g. financial structures, housing and staffing a practice, small practices versus large health centres, working within New Zealand's mix of private-public health services.
I was looking forward to a broader coverage of topics and hoping for some insights into what it is like to be a doctor in the present: my own training was so long ago I imagined the experience of training in a modern medical school, and the subsequent postgraduate years of learning and working would be full of fascinating new insights and enhancements. Unfortunately, many of these are implied rather than detailed.
Nonetheless, this book does provide a detailed examination of the basic relationships between unwell people and their (would-be) healers. It draws extensively from the authors' experiences as practitioners, and teachers of under- and postgraduates, as well as from social science literature. While it is difficult to encapsulate the wide range of chapter topics listed, the general theme of the book is that to have a paternalistic doctor making detached decisions on behalf of the patient is not an adequate model of practice for our current society. It is argued that it disadvantages all parties, and may contribute to delays in diagnosis and healing. Various strategies for improving matters are outlined.
Welcome emphasis is placed on the usefulness of self-reflection on the part of the doctor, and on the power of group processes. In the latter respect especially, if this book helps persuade doctors to move from working in isolation to working in multidisciplinary teams, while also using their peers for support and guidance, it will have achieved a good outcome. The role of a sick doctor as a patient is also examined: much can be learnt from their experiences.
''Shared decision-making'' is regarded as a desirable goal in much of medical practice today, so it was a surprise not to find it addressed in any depth as a specific topic. While shared decision-making can be reasonably straightforward in some instances (operation or no operation? Drug A or drug B?), the end of life often provides a major challenge to all parties and again this, while touched upon, is not covered in any depth.
A ''must-read'' for all clinicians? Yes, it probably should be, but given its length and complexity, it may be a challenge for the general medical reader.
- Chris Lovell-Smith is a recently retired Dunedin doctor.
