Family Practice Vol. 16, No. 5, 544
© Oxford University Press 1999
Book Reviews |
Critical reading for the reflective practitioner: a guide for primary care.
Professor of General Practice, University of Dundee, Scotland
R Clarke, P Croft. (342 pages, £22.50.) Butterworth-Heinemann, 1998. ISBN 0-7506-3939-3.
With the burgeoning growth and the notion of evidence-based medicine, critical appraisal is an important skill which all doctors need to understand. Compared with many books and articles on critical appraisal, this book is somewhat different in that it has a continuing focus on practical examples throughout the text. The book is divided into two sections. The first tackles the evaluation of an individual study. The main concepts are reviewed, as well as systematic ways of how the reader can critically reflect on a study or outline. The second section focuses on how to select and use literature on topics where several papers may be relevant.
Does the book achieve its aims? Its strength lies in the format that tries to avoid too much theory and follows up any description of terms such as bias, confounding variables and skewed distributions with good examples from the literature. For me, one of the most successful chapters is on implications for clinical practice. It is written in a way which indicates that the authors understand the difficulties faced by GPs trying to practice evidence-based medicine in the midst of the plethora of undifferentiated illnesses.
The second section uses hot topics such as asthma, diabetes, cervical screening and hospital referrals as common subjects where a variety of published articles have been produced in recent years. The authors correctly point out the limitations of using some of the results of these studies to develop crude measures of quality of care. A good example of this is the discussion about variation in referrals to hospital, which are due to a variety of factors, not least random variation over relatively brief periods of time. This section in particular should be required reading for those in management positions who despair at the lack of conformity in the clinical behaviour of GPs. Here they will find well-argued evidence against rushing to judgement about these variations in clinical practice.
If I had one criticism of the book it relates to the rather abrupt ending to section 2. It would have benefited from a summary of the key points on hot topics in general practice, which would have rounded off a well-thought account of how to judge the literature and common areas of clinical practice. Despite this, the authors have provided a more than useful guide to critical reading and its relevance to general practice.
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