The resourceful patient

Abstract

J. A. Muir Gray. Oxford: Alden, 2002. ISBN 1-04202-00-4. 154 pp. £14.95. Also free online version with additional resources via http://www.resourcefulpatient.org. Any book by Muir Gray is likely to be worth reading. He is a charismatic and influential doctor who continues to be involved at a high level in key health initiatives, and presents interesting and innovative ideas in an entertaining and thought-provoking way. His enthusiasm to embrace new ideas is shown in the hybrid production of this book. It is available as a print version, printed on demand, and also free online. The two forms aim to ‘maximize the benefits of each medium to present a single sets of ideas’, and will be regularly updated. Information is presented in small sections covering a wide range of issues, with references and links to websites that give more information or examples. The links appear as underlining in the print version, which does not include the URLs, but they can be found by checking on the e-book version. Giving patients more responsibility, such as sharing in decision-making, has been proven to have benefits for them, without having to cost any more. The author points out that patients therefore need the resources to be able to take more responsibility. It is acknowledged that some patients will be unable to become ‘resourceful’ and more responsible, and that some patients will need some basic measures such as interpreters between their language and English. The book is in four sections. The first describes the ‘Rise and fall of the medical empire—the evolution of medical power’, from a review of history to recent changes in ‘sapiental, moral, bureaucratic, and charismatic’ authority. It includes entertaining and illuminating quotes from a wide variety of sources. The fall in medical power should perhaps be put in the context of being a fall from a very high level of power to a level of power that is still high, but the points made are valid. The second section is titled ‘What do doctors do all day?’ and describes the wide range of activities this involves, from making a diagnosis and applying research findings (including interpreting risk data), to wider issues, such as providing information, allaying anxiety, and providing access to services. The third section is a wide-ranging discussion of the skills and resources needed for patients to be ‘resourceful’, such as ‘guidebooks’ for the patient journey, following guidelines together, and learning consultation skills. Ethical issues are covered, such as consent and involvement for children or people with learning disabilities. The final section suggests a new medical paradigm, where there would be a partnership with shared decision-making with patients, from real patient-centred care to a role in the development of services and guidelines. Screening is used as an example of what has happened and how this could be improved. ‘Resourceful’ patients might also be doing pre-consultation prep and post-consultation homework! The accompanying website contains all the text, with live hyperlinks. In addition to references and an order form for the print version, with option to customise, there is a ‘toolkit’, and a learning resources section that includes a model advance directive and e-consultation vignette for discussion. Implementing the initiatives mentioned in the book would need to include measures to raise more doctor-patient communication to a minimum basic level of respect and clarity. For example, a recent survey of hospital patients found that only 41% of patients thought they were given complete advice on danger signals about their illness to watch for on discharge, and 23% had experienced doctors talking in front of them as if they were not there.1 This book would be a thought-provoking read for any health information professional interested in consumer health information and the doctor/patient relationship. It is also an interesting example of hybrid publication, and one that goes beyond a simple static electronic version of the printed text. It is good to be offered the choice, particularly when the e-book is free. Hopefully, other authors and publishers will learn from this example.