An outline of sociology as applied to medicine

An outline of sociology as applied to medicine

Book Reviews The Dutch Sentinel Practice Network; Relevrmx for Public He&b 629 In this way a picture has been built up of patterns of of Dutch gen...

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Book Reviews The

Dutch Sentinel Practice Network; Relevrmx for Public

He&b

629

In this way a picture has been built up of patterns of of Dutch general practice. Such material provides the basis for the 13 chapters in this book, which is divided into two parts. The first part describes the ‘sentinel practices’ and how they work, while the second covers topics like infectious diseases, mental health problems and referrals; there is also a chapter on the contentious issue of requests for euthanasia. The final chapter provides some critical comment on the scope and limitations of what has been achieved and concludes that this kind of general practice based information service is an efficient and cost-effective tool for public health policy. The writing throughout is fluent and there are remarkably few textual errors-though it is evident that English is not the mother tongue of most of the contributors. Perhaps future editions might include an index to help the reader to pin-point specifics in such a broad coverage. The book is likely to be of interest to all concerned with health service planning-and the U.K. general practitioner will also feel very much at home with many of the issues described.

Policy, edited by A. I. M. BARTELDS, J. FRVZZHE~~OUDmorbidity and some of the characteristics

and J. VANDWI&a. The Netherlands Institute of Primary Health Care, 1989, 357 pp. Primary health care, for countries like the U.K. and the Netherlands, has a dual function. It provides for the needs and demands of most of the population most of the time. In addition, it acts as a gatekeeper, protecting the scarce expensive hospital-based services. Yet it has always been a curious anomaly that where health services have the greatest need for information they are least well served. The scene is beginning to change. In the U.K. the Birmingham research unit of the Royal College of General Practitioners has been tackling the problems since the 1950s and Dutch general practitioners have also been active in the field. This book brings together the cumulative experience of a system of information from general practice pioneered by the Netherlands. Unique features of the system include the use of the defined practice populations as a denominator, and the recording of information about selected health problems by those actually having the responsibility for providing the care. Using agreed criteria, the contributors feed data to a co-ordinating centre. The group agree on the topics to be studied, and these may vary from year to year. The list has grown over the 20 years of the existence of the system: topics include both health problems, like alcoholism and suicide, and also ways in which practitioners deal with them, for example by referral to hospital and issuing prescriptions.

An Outline of Sociology as Applied to Medicine, by DAVID

ARMSTRONG. 3rd edn. 1989. Wright, London, 139 pp. f8.95.

Armstrong was one of the first sociologists to recognise the value of providing medical and other students of health related subjects with an introductory text in the sociology of medicine and health, written directly with their likely interests and needs in mind. His success in doing so is evidenced by the appearance less than 10 years later of a third substantially revised edition. The rewriting reflects the changes which have taken place in the last decade in the perceptions of the value of particular types and schools of sociological theory when applied to issues of health and medicine. Armstrong has himself contributed to these changes (not quite, perhaps, a Kuhnian paradigm shift) by his espousal of Foucaultian concepts and his various innovative attempts to apply them to an understanding of contemporary medical practices and forms [l-3]. The style of the writing-singularly free of heavy jargon without descending into over-simplification-presumably reflects Armstrong’s own experiences both as a medical student, before he took the unconventional sideways step of graduating in sociology, and later as an academic in a London university medical school faculty teaching such students. The first edition of his book was rightly criticised for having no referencing at all. This one is immaculately done-not overdone-and with a short bibliography at the end of each chapter as well as a fuller one at the end. As an Outline it is not fair to look for any great depth of treatment of particular issues. Indeed, the number of topics on which he found it possible to say something of value in 15 chapters and 139 pages showed considerable skill in summarising the seminal work of the many theorists and

Department of General Practice University of Dundee Westgate Health Centre Dundee Scotland

J. D. E. KNOX

empirical researchers who have helped to construct a definitive body of sociological work which should inform those entering medicine or other health occupations. This reviewer thought the unsatisfying chapters were those which dealt with Clinical Autonomy, Delivering Health Care and Evaluating Heaith Care. They were too often based on questionable unreferenced data and made little use of sociological concepts or perspectives. Armstrong may have been constrained by the uncertainties which hung over the National Health Service of the U.K. (and the health systems of other countries too) at the time he wrote, which require more penetrating analyses than they have so far received from sociologists. But the analysis in his Introduction and earlier chapters of the strengths and weaknesses of the dominant biomedical model in contemporary orthodox medicine presents sociologists as well as his intended medical and other health student readers with an intellectually persuasive account well worth reading.

REFERENCES I. Armstrong D. The emancipation of biographical medicine. Sot. Sci. Med. 13, 1-8, 1979. 2. Armstrong D. Political Anatomy of the Body: Medical Knowledge in Britain in rhe 2Orh Century. Cambridge University Press, 1983. 3. Armstrong D. The patient’s view. Sot. Sci. Med. 18, 737-744, 1984. 32, Bisham Gara’ens London N6 600 England

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