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By John Launer. (Pp 264; £21.95.) Radcliffe Medical Press, 2002. ISBN 1-85775-539-1.
The progressive decline in GPs’ morale has resulted not only from an increasing workload, but also from awareness that patients, the NHS, and GPs themselves now place less value on the work that GPs perform. Having progressed from the traditional role of simply dispensing medicine and wisdom for an unquestioning grateful patient, GPs need to address the challenges of clinical governance, evidence-based medicine and patient empowerment, while maintaining their own sanity and even self respect.
Narrative-based medicine focuses on enabling a patient to “tell his story”. This forms the basis of an interaction where the listener’s intervention serves to “improve” the story. By embracing the patient’s narrative, GPs can understand his “agenda” and negotiate a management plan that is more likely to be acceptable and to work. John Launer guides the reader from the theory into the practice and teaching of this approach within the GP consultation. This requires the GP to become an expert listener (not just to what the patient says, but also how and when), and to become more reflective and honest (both intellectually and emotionally). Putting this into practice involves repeatedly testing ideas or beliefs (I was struck by the analogy to the approach of Popper) without undermining expertise, and then acting within “currently accepted systems of thought”, which will change over time. Open minded and reflective GPs, particularly those involved in teaching, will find this excellent book both thought provoking and useful. Already, I have changed my opening greeting to “What would you like to tell me about?”
The reviewers have been asked to rate these books in terms of four items: readability, how up to date they are, accuracy and reliability, and value for money, using simple four point scales. From their opinions we have derived an overall “star” rating: * = poor, ** = reasonable, *** = good, **** = excellent.