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In the patient's interest: Access to hospital care
little more illumination for those who have lo move m this complex area we shall be content”. And so they did and so am I.
In the Patient’s Interest: Access to Hospital Care, edited by MILDRED D. MAILICK and HELEN REHR. Prodist, New York, 1982. I71 pp. $15.00 This book might be better titled: In the Patient’s Merest? Although it begins by addressing questions of access, it is really a description of the roles of patient representatives within the hospital. Its focus. then, is on secondary issues of access rather than primary ones, The book begins with a somewhat dated but nonetheless interesting discussion about the multiple dimensions of access. It poses a series of problems about barriers to access, including the complexity of the modern health-care delivery system. A concluding chapter raises a parallel set of issues and suggests a variety of remedies and general policy areas for further attention. In between, we are offered a very detailed discussion about the growth of the patient-representative movement and the roles of such individuals within the hospital. Unfortunately. the authors fail to provide any convincing evidence that this movement responds to the questions raised in the introduction and conclusion. The data presented focus instead on of the hospitals to describe the patientsurveys representative programs and a series of case studies. Ironically, these case studies describe the reaction of the institution and the staff rather than the responses of patients. It would have been perhaps more useful to have learned something about how these patient representatives are actually able to act in the patient’s interest and some evidence that such actions improved access to care within the hospital. The volume traces the history of the patientrepresentative movement beginning with a discussion of information and referral services. The chapter on the community health ombudsmen, written by a lay person, is one of the outstanding chapters in the book. The chapter on the htstory of the Society of Patient Representatives is perhaps the least interesting. Overall. the volume is brief and easy to read. It suffers from the problems of multiple authors. The transitions between chapters are sometimes disjointed. There are several annoying repetitions of the same statistics from one author to the next. At the end. however. one has the sense of having learned more about aspects of the subject than one wanted to know without ever having gotten to the heart of the question. Are these people really effective? Can a group of individuals employed by a hospital really act in the patient’s interest? How often are they forced to defend the hospital to the patient? The authors allude to these kinds of problems, but don’t present any quantifiable information to give one a sense of how important they are. The book would have been very helpful had it been able to document changes in hospital performance after such a program had been instituted. The editors note in their introduction that the purpose of the book was to present possible programmatic solutions. which “may survive budget constraints and become permanent parts of the complex of access services or may disappear from the health-care scene”. Surely the fate of such a movement will depend on its ability to demonstrate its effectiveness. The Intended audience for this book is not clear. Students unfamiliar with the hospital environment and the problems of patients in that complex setting of high technology may Iind the first four chapters instructive. However. if one were
looking for a primary source on the subject, there are a large number of works that describe problems of gaining access to the health-care system and the plight of the hospital patient. It is not clear that the evidence presented in this book would be very convincing for a hospital administrator considering the introduction of such a program in his facility. Health-care providers may be sensitized by some of the material, but would leave the book unsatisfied that they had uncovered any good solutions about how to meet the challenges raised. The Rund Corporation UCLA School of Medicine and School qf Public Health Los Angeles. CA, U.S.A.
R~BEKT L. KANE
Toxicomanias. Un enfoque interdisciplinario, by F. FREIXA. P. A. SOLER er al. Coleccion Conducta Humana, No. 41. Editorial Fontanella, Barcelona, 1981 This is by far the most comprehensive effort undertaken in today’s Spain to describe and explain the wide spectrum of traditional and modem drug addictions, with special emphasis on their treatment and prevention. The book is a collection of related essays, written by an inter-disciplinary team of psychiatrists, psychologists, physicians, a pharmacologist, a lawyer and a journalist. The text responds to a pending need for professional information and guidance for all those working with the problem of drug addictions, from the physician to the social worker and to the public. The author’s opinion is that there is a complex drug problem in Spanish society. The reasons are two. On the one hand, addiction occurs because this culture is a traditional consumer of so-called ‘legal drugs’ (alcohol, tobacco and coffee); and, on the other, because during Spain’s rapid industrial and urban development of the 1960s and 1970s there was a tremendous increase in the consumption of the above-mentioned drugs. In addition, a complete myriad of illegal drugs, both ‘hard’ and ‘soft’, appeared on the social scene. According to our researchers, such a problematic and complex situation is. first of all, not well understood by the health-services community, due to the fact that its members are themselves unconsciously or defiantly, very dependent on legal drugs. Added to this basic factor is the question of expansion of the government-controlled tobacco industry, the lack of restrictions on the advertising of alcoholic beverages. and the virtual absence of effective medical and social programs to inform and aid the population in general, as well as the addicts. In the first section of the book, the authors venture into the intricacies of drugs and human consumption. In so doing. they describe general concepts, drug classifications. socioeconomic aspects, and the biochemical and neurophysiological foundations of drug dependency. The essays in the second part analyse, in great detail, each main drug (tobacco, alcohol, cannabis, opiate, etc.). namely, its sociohistorical background as well as its most relevant pharmacological and chemical aspects. The book’s third section adopts a sociological orientation as it focuses on factors such as drugs and social deviance. counterculture. advertising, consumption and drug-related legal considerations. Although a comparative approach (including an overall treatment of drugs by Western civilisation) is considered, special emphasis is given. whenever possible. to the case of Spain. The text concludes with a practical section. Four essays by the main authors, who are pioneers in this field. deal with the problems involved respectively around the medical treatment of drug addiction to legal and illegal drugs. as well
In the Patient’s Interest: Access to Hospital Care, edited by MILDRED D. MAILICK and HELEN REHR. Prodist, New York, 1982. I71 pp. $15.00 This book might be better titled: In the Patient’s Merest? Although it begins by addressing questions of access, it is really a description of the roles of patient representatives within the hospital. Its focus. then, is on secondary issues of access rather than primary ones, The book begins with a somewhat dated but nonetheless interesting discussion about the multiple dimensions of access. It poses a series of problems about barriers to access, including the complexity of the modern health-care delivery system. A concluding chapter raises a parallel set of issues and suggests a variety of remedies and general policy areas for further attention. In between, we are offered a very detailed discussion about the growth of the patient-representative movement and the roles of such individuals within the hospital. Unfortunately. the authors fail to provide any convincing evidence that this movement responds to the questions raised in the introduction and conclusion. The data presented focus instead on of the hospitals to describe the patientsurveys representative programs and a series of case studies. Ironically, these case studies describe the reaction of the institution and the staff rather than the responses of patients. It would have been perhaps more useful to have learned something about how these patient representatives are actually able to act in the patient’s interest and some evidence that such actions improved access to care within the hospital. The volume traces the history of the patientrepresentative movement beginning with a discussion of information and referral services. The chapter on the community health ombudsmen, written by a lay person, is one of the outstanding chapters in the book. The chapter on the htstory of the Society of Patient Representatives is perhaps the least interesting. Overall. the volume is brief and easy to read. It suffers from the problems of multiple authors. The transitions between chapters are sometimes disjointed. There are several annoying repetitions of the same statistics from one author to the next. At the end. however. one has the sense of having learned more about aspects of the subject than one wanted to know without ever having gotten to the heart of the question. Are these people really effective? Can a group of individuals employed by a hospital really act in the patient’s interest? How often are they forced to defend the hospital to the patient? The authors allude to these kinds of problems, but don’t present any quantifiable information to give one a sense of how important they are. The book would have been very helpful had it been able to document changes in hospital performance after such a program had been instituted. The editors note in their introduction that the purpose of the book was to present possible programmatic solutions. which “may survive budget constraints and become permanent parts of the complex of access services or may disappear from the health-care scene”. Surely the fate of such a movement will depend on its ability to demonstrate its effectiveness. The Intended audience for this book is not clear. Students unfamiliar with the hospital environment and the problems of patients in that complex setting of high technology may Iind the first four chapters instructive. However. if one were
looking for a primary source on the subject, there are a large number of works that describe problems of gaining access to the health-care system and the plight of the hospital patient. It is not clear that the evidence presented in this book would be very convincing for a hospital administrator considering the introduction of such a program in his facility. Health-care providers may be sensitized by some of the material, but would leave the book unsatisfied that they had uncovered any good solutions about how to meet the challenges raised. The Rund Corporation UCLA School of Medicine and School qf Public Health Los Angeles. CA, U.S.A.
R~BEKT L. KANE
Toxicomanias. Un enfoque interdisciplinario, by F. FREIXA. P. A. SOLER er al. Coleccion Conducta Humana, No. 41. Editorial Fontanella, Barcelona, 1981 This is by far the most comprehensive effort undertaken in today’s Spain to describe and explain the wide spectrum of traditional and modem drug addictions, with special emphasis on their treatment and prevention. The book is a collection of related essays, written by an inter-disciplinary team of psychiatrists, psychologists, physicians, a pharmacologist, a lawyer and a journalist. The text responds to a pending need for professional information and guidance for all those working with the problem of drug addictions, from the physician to the social worker and to the public. The author’s opinion is that there is a complex drug problem in Spanish society. The reasons are two. On the one hand, addiction occurs because this culture is a traditional consumer of so-called ‘legal drugs’ (alcohol, tobacco and coffee); and, on the other, because during Spain’s rapid industrial and urban development of the 1960s and 1970s there was a tremendous increase in the consumption of the above-mentioned drugs. In addition, a complete myriad of illegal drugs, both ‘hard’ and ‘soft’, appeared on the social scene. According to our researchers, such a problematic and complex situation is. first of all, not well understood by the health-services community, due to the fact that its members are themselves unconsciously or defiantly, very dependent on legal drugs. Added to this basic factor is the question of expansion of the government-controlled tobacco industry, the lack of restrictions on the advertising of alcoholic beverages. and the virtual absence of effective medical and social programs to inform and aid the population in general, as well as the addicts. In the first section of the book, the authors venture into the intricacies of drugs and human consumption. In so doing. they describe general concepts, drug classifications. socioeconomic aspects, and the biochemical and neurophysiological foundations of drug dependency. The essays in the second part analyse, in great detail, each main drug (tobacco, alcohol, cannabis, opiate, etc.). namely, its sociohistorical background as well as its most relevant pharmacological and chemical aspects. The book’s third section adopts a sociological orientation as it focuses on factors such as drugs and social deviance. counterculture. advertising, consumption and drug-related legal considerations. Although a comparative approach (including an overall treatment of drugs by Western civilisation) is considered, special emphasis is given. whenever possible. to the case of Spain. The text concludes with a practical section. Four essays by the main authors, who are pioneers in this field. deal with the problems involved respectively around the medical treatment of drug addiction to legal and illegal drugs. as well