The elderly

December 2012

Back pages

Book reviews

Volume 41, No.12, December 2012 Pages 994-995

Books reviewed this month are Contraception: An Australian clinical practice handbook, 3rd edition by Family Planning New South Wales, Queensland, Victoria, Oral, nasal and pharyngeal complaints: A practical guide by Geoffrey G Quail, Managing depression, growing older: A guide for professionals and carers by Kerrie Eyers, Gordon Parker and Henry Brodaty, and The good doctor: What patients want by Ron Paterson.

Contraception: An Australian clinical practice handbook, 3rd edition

Family Planning New South Wales, Queensland, Victoria

Australia: Family Planning New South Wales, Queensland, Victoria, 2012 ISBN 978 0 9872962 1 4, $60.00

Available from http://shop.fpq.com.au

Contraception: An Australian clinical practice handbook, 3rd editionConsultations with women making reproductive choices are an important part of daily practice. The third edition of this tried-and-true handbook is an important resource, providing clinically relevant, evidencebased, woman centred and easy to understand guidelines.

'Contraception' is primarily written by the Medical Directors of Family Planning New South Wales, Queensland and Victoria – Drs Deborah Bateman, Caroline Harvey and Kathleen McNamee, respectively. These doctors are all experienced clinicians in the area of reproductive health and the handbook authoritatively draws on their collective experience and synthesised international evidence. A range of other experts have been consulted for particular sections and were involved in reviewing the work. The currency and comprehensiveness of the references cited is particularly impressive, as is the index and list of acronyms.

Road-testing the handbook in my clinical practice over the past few weeks has found it to be a very useful reference. The layout is practical, with a chapter on each category of contraceptives (including, importantly, emergency contraception) and a particularly useful chapter covering contraception in specific circumstances. The introductory chapter covers the availability and quality of evidence about different methods, the United Kingdom Medical Eligibility Criteria, concepts of contraceptive effectiveness in practice and the slightly fraught process of initiating contraception. Within each of the contraceptive methods chapters, sections are devoted to mechanism of action, effectiveness, advantages and disadvantages, contraindications, history, examination, side effects, dose, review, management of side effects and so on. Particularly useful were the sections on information for users and issues to discuss and listings of various combined oral contraceptives by components and PBS listing. It reminded me of how dangerous complacency can be, as we get comfortable in clinical practice and forget the finer details – I found myself learning more each time I dipped into it.

The only additions that I could think of that may improve subsequent editions would be a listing of online information for patients about each contraceptive choice. The judicious use of diagrams and illustrations (for example photos of different pill packets) could also be considered. Overuse of acronyms could be a barrier initially for non-experts, however the glossary and list of acronyms is clear and comprehensive, and it doesn't take long to catch on!

In summary, while not a particularly attractive or showy addition to the bookshelf, this handbook will quickly find itself dog-eared and well thumbed. More than a doorstop, it is destined for frequent reference, for sharing with registrars and medical students and for consulting together with patients.

Dr Sarah Larkins
Townsville, Qld

Oral, nasal and pharyngeal complaints: A practical guide

Geoffrey G Quail

Sydney: McGraw-Hill, 2011 ISBN 978 0071 013 048, $80.00

Oral, nasal and pharyngeal complaints: A practical guideEar, nose and throat conditions are among the most common and complex of problems encountered in general practice. The author of this book, Geoffrey Quail, is a person of double degrees – medicine and dentistry. He has practised as a GP and for a time was Senior Lecturer in the Department of General Practice, Monash University. He has also served as an Associate Professor in the Department of Surgery at Monash University where he is and has been Director of the combined Dental and Maxillofacial Surgical Unit at Southern Health. With the assistance of Douglas Buchanan, Senior Consultant in Ear, Nose and Throat Surgery, Southern Health and Rowan Story, Emeritus Consultant in Oral and Maxillofacial Surgery, Southern Health, Geoffrey Quail has presented an excellent pictorial guide to a broad range of ear, nose and throat problems.

The educational approach of the book, which could be described as an 'atlas', is interesting and commendable. There is a presenting problem approach for conditions such as 'the painful mouth', 'oral ulceration', 'swellings in the mouth', 'the sore throat' and 'halitosis' and his approach is complemented by visual presentation on regional malignancies. There is an excellent chapter on maxillofacial and dental trauma and a practical section for the general practitioner on common oral and nasal procedures.

In his foreword, Professor Vernon Marshall summarised the book as follows: 'How I wish such a useful text and primer was available to me in my early student and graduate years when confronted with difficult problems at the coalface. I am sure that current and future generations of trainee doctors and dentists will find the book an invaluable and regularly thumbed through addition to their shelves'.

Emeritus Professor John Murtagh
Melbourne, Vic

Managing depression, growing older: A guide for professionals and carers

Kerrie Eyers, Gordon Parker, Henry Brodaty

Australia: Black Dog Institute, 2012 ISBN 978 1742 378 800, $27.99

Managing depression, growing older: A guide for professionals and carersA sensitive and thoughtful treatment of the complexities associated with ageing and managing depression, this book is a must for anyone who has ever cared for an older person with depression or grappled with the 'black dog' themselves. Written in a highly accessible format, using nontechnical language, this is a quick and easy read, explaining complex ideas simply (but without simplifying them). Comprising 12 chapters, 'Managing depression' is filled with patient and carer vignettes, case notes from psychiatrists, and pithy 'noteworthy' summaries at the end of each chapter.

At times, clinical and at other points deeply personal, what stands out are moving accounts of managing depression successfully in some cases, but failing to do so in others. This is a real strength of the book. In particular, the reflections of the psychiatrists who have contributed, all luminaries in their field, highlight the challenges of diagnosing and treating an older person with depression. The reflexivity and willingness of these practitioners to discuss their professional practice, explore polemic and ethical problems and place their patients at the centre of their practice is commendable. Such professional practices are easy to espouse but often hard to do in circumstances constrained by time scarcity and resource shortages. Through their experiences, key insights are offered into the symptomology of depression in older people, structured methods of assessment, types of depression, therapies and the role of the therapist, and the efficacy of different treatments and psychotherapies available.

Moreover, in editing this collection, the editors have clearly taken a big picture view on the subject matter with excerpts on issues extending well beyond the clinic. These include the structure and delivery of care in institutional facilities, overcoming the dual stigmas associated with ageing and depression, the travails of caring long distance, caring for the carers, and the importance of self efficacy and patient empowerment.

Overall, this is a useful read and of relevance to GPs. However, there are two shortcomings: first, the authors could have had a greater presence in the text. Their considered opinions could have helped advance debates on health and care service planning and policy development in the aged care-mental health nexus. Second, there could have been greater attention to the challenges GPs face in diagnosing and managing depression in older people. Including only psychiatrists' experience leaves unaddressed the unique challenges faced by busy GPs in their practices. But perhaps this is a subject for another book by the publishers at the Black Dog Institute? In the interim this important book offers valuable assistance to professionals and carers in managing depression in older people.

Dr Bianca Brijnath
Melbourne, Vic

The good doctor: What patients want

Ron Paterson

Auckland: Auckland University Press, 2012 ISBN 978 1 86940 592 2, $39.95

The good doctor: What patients wantCharged with promoting and protecting patients' rights as New Zealand's Health and Disability Commissioner between 2000 and 2010, Professor Ron Paterson writes from his experience of listening to patients and doctors and his considered analysis of events, which reveal gaps in medical self-regulation.

Paterson recognises that most doctors are good, dedicated, professional and highly committed to their patients, that patients report very high levels of satisfaction with their own doctor and that the public scores doctors very highly in polls of trusted professions. But this does not protect the public from the few who are not good doctors. In an ideal world, the public would know that every registered doctor is competent and patients could trust that the regulatory systems would provide that assurance. However, in real life, the Shipman enquiry in the United Kingdom as well as events closer to home such as the Gisborne Cervical Screening Inquiry have demonstrated the discrepancy with that ideal world.

The author points out that within the medical community it is often common knowledge that a certain doctor should be avoided for the care of one's own family but the general public is not privy to such information. Patients rate technical competence (knowledge, training, experience) as the most important attribute in the choice of doctors but cannot satisfactorily assess this themselves and must rely on regulators for this. They can assess human qualities, which are also important to them such as whether the doctor puts patients first, trustworthiness, communication skills, respect and caring. Valuable as these qualities are, history has shown that they do not equate with clinical competence.

Paterson describes the tensions between over-regulation of doctors and over-reliance on professionalism and between self-regulation and external regulation. He summarises changes in regulation around the world and outlines a 'prescription for change' in which he calls for better information for patients about doctors: their qualifications and their registration status, better checks on doctors through recertification and legislative reform to increase external influence and transparency in medical regulation.

This book was written to stimulate debate. It will be confronting to many as it makes a robust argument for change and change is always uncomfortable.

When will we know that we have reached the promised land of safe, patient centred-care? Paterson recollects the words of a Californian health policy expert, Arnold Milstein in the answer: 'When physicians are willing to accept random allocation of a physician for their own and their families' medical care'.

Associate Professor Moira Sim
Joondanna, WA

Correspondence afp@racgp.org.au

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Book reviews

2012