proving Communication in Med- ical Visits. Debra L. Roter and. Judith A. Hall. 203 pp. Greenwood. Publishing Group, Inc., Westport,. Conn. 1992. $45 (US).
BOOKS * LIVRES
On good communication Doctors Talking with Patients/ Patients Talking with Doctors: Improving Communication in Medical Visits. Debra L. Roter and Judith A. Hall. 203 pp. Greenwood Publishing Group, Inc., Westport, Conn. 1992. $45 (US). ISBN 086569-048-0 T n his book will be of value to researchers, curriculum planners, physicians, students and patients who are interested in research on doctor-patient communication. But beware! This is not a "how to" book: although it contains much good advice it does not teach the techniques of effective inter-
viewing. The authors begin with the premise that "talk is the main ingredient in medical care and that it is the fundamental instrument by which the doctor-patient relationship is crafted and by which therapeutic goals are achieved." They present overviews of numerous studies to prove their point, that effective communication has important effects on the outcome of illness, including patient satisfaction, compliance with therapy and physiologic recovery. Four models of the doctorpatient relationship, which are based on degrees of control, are described. The traditional paternalistic model has high doctor control and low patient control: the doctor is in charge and the patient is passive. The increasingly popular model of consumerism consists of low doctor control and high patient control. In a study in which patients were followed up for 1 week after an office visit, active patients had less discomfort, fewer symptoms and an overall better condition than passive patients. In the third model, mutualNOVEMBER 15,1993
ity, both doctor and patient control is high: "Each of the participants brings strengths and resources to the relationship, as well as a commitment to work through disagreements in a mutually respectful manner." The final model is characterized by a total lack of control by either party. The authors describe research into the factors involved in the doctor-patient relationship: patient characteristics such as age, sex, social class, ethnic background and features such as dress and personality attributes; physician characteristics such as sex, social class, political ideology, personality characteristics and medical training; and the forms of exchange between the protagonists such as patterns of talk, and giving and withholding of information. The final section summarizes research into the relation between talk and outcomes of care and reviews intervention studies to improve talk. The good news is that communication can improve, with surprisingly simple and inexpensive strategies. One caveat is that the book is not a comprehensive review or a meta-analysis of all research. Rather, it presents a fairly large sample of the literature to illustrate the authors' point of view. The studies are presented briefly and without critical comment, so it is impossible for the reader to judge their validity or generalizability. But to provide that much detail would require a bigger, less "user-friendly" book that would not reach the intended audience: the person who wants an overview of research that can be read with enjoyment in a few hours. This book is a gem! It provides a firm foundation for an evidencebased approach to doctor-patient communication that is clear, concise and engaging. The next time some-
one tells you that "doctor talk" is simply the art of medicine and cannot be taught or learned, refer him or .her to this book. W. Wayne Weston, MD Assistant dean for faculty development Faculty of Medicine University of Western Ontario London, Ont.
Listening to advice Sexual Abuse Counselling by Family Practitioners: Issues Across the Treatment Process and Management Strategies. Gary Direnfeld. Audiocassette and companion booklet. 13 pp. Illust. Secrets of the Trade, 20 Suter Cres., Dundas, ON L9H 6R5; (416) 628 4847. 1993. $35 (set). ISBN 1-89585303-6 T n his hour-long audiocassette is accompanied by a booklet of case histories and diagrams. The cassette was produced at McMaster University Medical Centre during two live sessions in which Gary Direnfeld used his experiences to answer family practitioners' questions and outlined some basic issues in the diagnosis and treatment of sexual abuse survivors from a relatively newcomer's point of view. The questions are answered with clear, lucid, practical and easyto-digest advice. The diagrams and case histories are clear and succinct. Most of the issues are generally well presented. However, this home-made tape does not have a clear sound, the physicians' questions are often hard to hear, and the language is conversational and repetitious. The conversation at the end of the first side of CAN MED ASSOC J 1993; 149 (10)
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