Quality in Primary Care Open Access

The involvement of patients in their own health care is recognised to be important, but may be difficult in practice, particularly when patients are older.

This brochure has been developed as a result of an international study of ways to involve older people in their health care in general practice (the IMPROVE study), and includes five instruments for improving the involvement of older patients, which the authors have adapted from pre-existing sources. These in-clude: question sheets to help patients prepare for the consultation and make the most of their time with the doctor; The Patient Change Chart – a visual aid to support patients in discussing changes in areas of their life such as diet or exercise; and a Health Diary in which patients can record their health status over a period of time. The instruments look easy to use, with the possible exception of the Health Diary, which some older patients may find a little daunting.

It is unfortunate that the brochure does not include any guidance as to the use of the instruments. The collection would be of more value if each instrument were accompanied by background information, and some guidance on using it in the context of a consul-tation, including potential problems or drawbacks.

The collection is likely to be a useful resource for clinicians and policy makers wanting to facilitate the involvement of older people in their own care. A copy of the brochure can be downloaded from the IM-PROVE study website:  www.patientinvolvement.info

Wesley C Finegan

Radcliffe Medical Press: Oxford, ISBN: 1-85775-877-3, 2004, 192 pp, £14.95

Dr Finegan’s book, with its catchy title and clear, easy to read layout is surely a welcome addition to the library available to our often information hungry patients. In a logical and novel way using the TAN-DEM mnemonic (Think; Act; Note; Do; Explore; More information) he covers a wide range of common symptoms experienced by patients with a diagnosis of cancer, prefacing each chapter with a section entitled ‘The doctor says’. The language used is plain and easily understood, but be aware that as a clinician reading this book, you may feel it is overly simplistic and paternalistic. I found I had to actively remember to put myself in the place of the patient.

Physical problems covered include pain, appetite, breathlessness, constipation and diarrhoea, itch, lymphoedema and dry mouth to name but a few. Most are dealt with well for the intended scope of this book, but the information is patchy in place, and the messages contradictory in others.

It was heartening to see the inclusion of many chapters under the umbrella of ‘Personal, social and spiritual problems’. Too often, texts do not venture into this emotional and sometimes difficult area. The chapter ‘I am expecting bad news’ is particularly well written, as are those discussing body image, employ-ment and feelings of wanting to give up. Unfor-tunately, breaking bad news to children, a topic of great concern to many parents, appears incomplete and doesn’t adequately communicate the wealth of support and assistance available in this area. The hospice chapter is also shorter than expected, with an over-emphasis on respite care.

The main omission in this book, I feel, is that it does not address the issues of death and dying. The subject is hinted at on several occasions, but surely deserves inclusion as a chapter or chapters in its own right. Patients think about it, talk about it and would probably welcome reading about it.

Overall this is a book patients will probably wel-come and find useful and is, for all my reservations, well-written and informative. It may appear biased more to the cancer patient who is more likely to be treated and recover though, and some caution on its recommendation to patients is warranted.