Reviewer: Gary M. Ferenchick, MD (Michigan State University)
Description: This book is a description of the authors' model for analyzing the many ways doctors and patients interact. The authors identify public and personal aspects of this interaction which, once understood, help clinicians understand the clinical transaction.
Purpose: The purpose is to explicitly identify the intrinsic counseling skills that doctors need to bring to the medical encounter in order to guide it to a successful outcome, at times navigating fairly difficult transactions. Although entering an intellectual market increasingly saturated with books on doctor-patient interactions, the need for yet another book on this subject is underscored by the tremendous increase in evidence over the past 20 years that such skills are not innate but can be specifically and successfully taught to clinicians.
Audience: The book is targeted to all medical practitioners who wish to understand and improve their interactive skills with patients. It is appropriate reading for most clinicians who have had opportunity to experience clinical interactions (as we all have) which have left them baffled as to why the patient was angry, refused obviously helpful therapy, was non-compliant, etc. The authors have written several articles and manuscripts on this subject and this book appears to be a culmination of some of their previous work.
Features: The authors dissect the clinical encounter into its many features, from data gathering and interpretation to managing the patient's problems. Then section by section they delve into the task of analyzing why straightforward clinical interactions are straightforward and why complicated transactions are complicated. In each chapter, key content is embellished with brief vignettes, which help to place the theoretical model into real clinical scenarios common to any clinician who manages patients regularly. It is this feature, the "stories" of patients and doctors, that is particularly helpful and interesting. The authors' background appears to be rooted in psychoanalytic tradition, where personal insight and self-awareness represent key features that facilitate the clinician's ability to successfully work with patients to attain satisfactory outcomes.
Assessment: This book is worthwhile reading for all clinicians interested in facilitating meaningful interactions with their patients. I found it easy to read and generally well referenced; it compares favorably to other books I've had the opportunity to read on creating meaning in the clinical encounter, including Robert Smith's The Patient's Story: Integrated Patient-Doctor Interviewing (Little Brown, 1996).