The new consultation: developing doctor-patient communication. David Pendleton, Theo Schofield, Peter Tate, Peter Havelock (eds). (143 pages,  19.95.) Oxford University Press, 2003. ISBN 0-19-263288

Abstract

Book reviews 117 What is missing is any discussion of survival skills. Maybe the health care system in Australia is different, but in the UK the mismatch, between demand and expectations on the one hand and financial and personal resources on the other, creates conflicts for health professionals and between them and their patients. It is now recognized that, for many aspects of quality improvement in health care, it is as important to look at the system and the way it works as to focus on the individuals working in it. Shift systems can increase workload and diminish continuity of care, and demands for throughput can diminish the time available for each individual patient. These pressures are felt most acutely by junior hospital doctors at a time when they are learning their style of communication and their attitude to patients and patient care. It is easy to see how the tender flower of patient centredness, sown and nurtured during medical school, can wilt and die in the hot house of the emergency room. The book uses the article by Watson and Crick in Nature in 1953 as a case study in writing an effective report. It is only 950 words long, uses the active voice and simple language with minimal jargon. By choosing this paper as an example of clear, concise and purposeful writing, the authors of this book set themselves a very high standard, which they have largely achieved. They have also moved forward the agenda for learning and teaching effective communication in health care. The consultation is the core of medicine. Consultations make up more than two-thirds of the workload of a family doctor, but the number of books on the topic is surprisingly small. Those who have read these authors' first book on the consultation, 1 like me, probably couldn't wait to read this second book on the same topic. Although the authors explain that this book is new, rather than a second edition of their first one, because the thinking and emphasis have changed, I still could not help feeling the other way while I was reading it. The book is divided into two parts. Part one describes the consultation in the context of the cycle of care and argues how patient, doctor and contextual factors can affect the outcome of care. The chapter on 'Understanding the patient' is an excellent review on the current literature on the relationship between patient-centred practice and the outcome of care. The authors recap the seven consultation tasks that were described in their 1984 book; they then summarize the research findings in the last two decades that have validated their theory. They end with a revision of the seven consultation tasks with greater emphasis on patient-centred communication. The seven tasks are re-packaged into five tasks to be done within the allocated time, but it is not very clear how the conversion is done. Part two of the book gives a useful overview on the current thinking on effective adult learning and some practical examples on how the skills of a patient-centred consultation can be learned, taught and assessed in different settings. However, most of the information is based on the UK experience, which may not be generalizable to practices in other parts of the world, especially developing countries where the average consultation time is often less than 5 minutes and vocational training in family medicine is poorly funded.