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Shared Care in Gastroenterology. Travis S, Stevens R, Dalton H. (Pp 226; illustrated; £22.50.) Oxford: Isis Medical Media, 1997. ISBN 1-899066-40-6.
The relationship between general practitioners and gastroenterologists has, generally, been a better one than with most other specialists. In the UK, this has in part been due to long fostered relationships between the British Society of Gastroenterology and the Primary Care Society for Gastroenterology. Also, there is a closely shared and common clinical agenda between general practitioners and gastroenterologists. Some aspects of gastroenterology, particularly dyspepsia, are managed essentially in primary care and there is a healthy, if sometimes competitive, dialogue between the professions.
This book reflects this ethos, exploring common ground through a patient centred approach. In doing so it meets the new challenges facing clinicians through the restructuring of the NHS and the advent of the Primary Care Groups, which are likely to seek closer and more meaningful dialogue across the primary-secondary care interface. The authors, a general practitioner and two specialists, offer an intelligent entree into the concepts of shared and managed care, both of which are likely to be the basis of much future health transactions within the NHS.
The authors have managed to cover the gamut of gastroenterological problems without mimicking a traditional topic based textbook. They draw upon the experiences of mixed groups of general practitioners and specialists who have discussed shared care in specific situations. The book contains copies of shared care cards and other materials of practical use—for example, for inflammatory bowel disease. Colon cancer and polyps are particularly well described with a review of management options of value from both general practice and hospital viewpoints. An early section on clinical skills is especially engaging although it might have been augmented by reference to the relatively poor predictability of clinical diagnoses. In a world of increasing use of diagnostic and referral facilities a closer examination of the uncertainty and dilemmas faced by the general practitioner would have been welcome. Many general practitioners believe that gastroenterologists rarely make clinical diagnoses at the initial consultation: they merely order tests! Equally, the authors have managed to evade a critical review of one of the most contentious areas in reflux management: whether to step “up” or “down” therapy, and the appropriateness of long term treatment with potent drugs.
This does not, however, take away from an excellent book presented in compact softback version. It is likely to appeal to the general practitioner for diagnosis and management, to the specialist registrar for easy reference and to the consultant seeking closer collaboration with primary care. It does extend beyond the basics, even has a section on patient support groups and recognises the realities of the changing environment of the NHS. It’s worth buying.
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