Family Practice Vol. 18, No. 2, 239
© Oxford University Press 2001
Book review |
Smart health choices: how to make informed health decisions.
Judy Irwig, Les Irwig, Melissa Sweet. (226 pages, AU$17.99.) Allen & Unwin, 1999. ISBN 1-86508-146-9.
Senior Lecturer in Primary Health Care, Unit for Evidence-Based Practice and Policy, University College and Royal Free Hospitals Medical School, London
If the last decade of the 20th century belonged to the empowered and assertive patient, the first decade of the 21st belongs to the person who is master of his or her health choices. The former patient demanded information; the latter already has plenty—and knows what to do with it. The former entered the consulting room with a newspaper clipping, demanding to be put on the latest ‘wonder drug’; the latter knows that new is not necessarily better and might even write to the manufacturer asking for evidence from randomized controlled trials before troubling you at all. The former wanted a blood test to confirm that they were free of cancer and that their cholesterol level was ‘okay’; the latter is familiar with the vocabulary of false positives and false negatives and knows that ‘okay’ may not be an appropriate adjective to describe where an individual lies on a continuum of risk for future disease states.
‘Smart Health Choices’ is the first of what is likely to be a minor industry of books that aim to enlighten the public about the principles of clinical epidemiology and evidence-based medicine. We should, of course, welcome the genre, since an assertive, information-rich patient who can distinguish sense from nonsense is likely to make less trouble (and more appropriate health choices) than a similar patient who cannot.
Prepare, then, for your patients to consult you equipped with the Irwig's five-point checklist for evaluating treatment options: 1. What would happen if I did nothing? 2. What are the intervention options? 3. What are the benefits and harms of each? 4. How do the benefits and harms weigh up for me? 5. Do I have enough information to make a choice? If the answer to the last question is ‘no’, prepare to enter the loop of the algorithm that requires you to go back to the literature and report back in a language your patient understands.
‘Smart Health Choices’ is written by an expert in evidence-based medicine and two lay people with an interest in advocacy and communication. It is presented from the perspective of the Australian health care system and some of its specific recommendations may not apply directly to other health systems (e.g. those free at the point of care). Nevertheless, the book is both scientifically accurate and generalizable and it is attractively presented. However, explaining the finer points of likelihood ratios and numbers needed to treat is a tough task even with a professional readership. Will the patients grasp the right end of the stick? Perhaps the publisher should engage a large and representative sample of us in a post-marketing surveillance exercise to find out.
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