University of Wisconsin-Whitewater, USA

Muir Gray JA.The Resourceful Patient.Oxford: eRosetta Press, 2002

Economic, social and technological shifts have changed medical care, affecting relationships between patients and health professionals. Patients and clinicians are using new strategies and sources for acquiring health information, including the Internet. Patients may be equipped with information from Internet web searches and online support groups when they arrive at a psychologist or psychiatrist‘s office door. The Resourceful Patient is useful for understanding this trend.

As people attempt to take control of aspects of their lives, the alleged `experts‘ are being questioned on many fronts. This book addresses resulting developments in the medical realm. It has four sections: 1) the rise and fall of the medical empire; 2) what doctors do all day; 3) resources that patients require to share responsibility and assume more control, and 4) the shape of 21st century healthcare for patients, clinicians and organisations. The first part of The Resourceful Patient outlines the development of the medical establishment in Western nations and provides practical know-how for navigating medical sites. The material may seem simplistic to medical professionals and academics, but provides background for those less immersed in the medical realm. The second section demystifies the medical professions, providing a glimpse of a doctor‘s activities and showing how little time doctors spend with patients. Patients who feel that they are short-changed by their doctors will benefit from this section and find that their concerns are shared by others. The third section is arguably the most useful, containing sources and strategies for people to take charge of their interactions with health professionals (especially concerning medical records). The final section provides some hope and direction for the 21<sup>st</sup> century clinician. Not surprisingly given the book‘s technological know-how, this section benefits from a detailed exploration of Internet-related issues. For instance, `e-consultations‘ are explained in a manner free from the hype that often accompanies descriptions of high tech advances. The book also has a valuable toolkit of resources to assist people wanting a larger role in their healthcare, including official papers and books screened for quality.

Who is the audience for this book? Members of the medical profession, including psychiatrists and psychologists, should know of its existence and recommend it to patients if appropriate, although people seeking treatment may not always have the energy and know-how to use the material. For example, the book calls for evidence-based patient approaches where the patient helps to steer experts toward research-based, empirical analyses. Yet patients are often in weakened conditions and their energies are heavily invested in healing themselves and sustaining their damaged careers and overtaxed families. Few patients will have the capacity to completely fulfil the role outlined in this book. Perhaps the materials would be most useful in higher education classes to jumpstart a generation and build the critical mass needed to support evidence-based care. The book would also be well placed in discussion groups in community centres to foster a culture of resourcefulness.

I read the book online, but have obtained paper copies for several students I advise. It is the type of book that one wants to hand physically to friends and associates, especially those who have become bewildered in their interactions with medical professionals. Print copies are rendered in small batches and the book is reportedly being updated constantly.

An excellent book such as this will often inspire further reading. In reviewing this book, I went back to other sources of value for both patients and the medical community. The Social Transformation of American Medicine is somewhat dated, but is valuable for understanding medicine in its current incarnation.¹ Another book that deserves a second look is Cybermedicine.² It outlines some pioneering visions of the Internet-enhanced medical world. Both books serve as reminders of a less network-intensive age, in which books did not have hyperlinks to other books. The Resourceful Patient provides an overwhelming assortment of resources, nicely arranged, but one can be easily catapulted into ‘information overload.’

Just as it ‘takes a village to raise a child’ (US Senator Hillary Clinton‘s borrowed slogan), it also ‘takes a village to support and treat a patient.’ A variety of support systems (including professional and volunteer) must emerge if patients are to benefit substantially from Internet-enhanced medical care. The patient-empowered vision of the future presented by Muir Gray is enticing. The book underscores the importance of patient responsibility, not political action, in the process of change. It is written so openly and so engagingly that even those who espouse extensive political action will find much of value. Change can stem from an individual‘s request for more help as well as a legislator‘s demands. A minor shortcoming of the book is its relative downplaying of the role of adjunct professionals who could support patients in their efforts, including emerging professions such as ‘medical information assistants’ who buttress patients‘ efforts to explore their options via the Internet. The status of social workers, health educators and related health professionals may also be bolstered as they develop ways to empower and support consumers‘ Internet use.

The Resourceful Patient can be purchased online at http://www.resourcefulpatient.org/ for £14.50. The text is also available free online at this site

1. Starr P. The Social Transformation of American Medicine. New York: Basic Books, 1982.
2. Slack WV. Cybermedicine. San Francisco: Jossey Bass, 1997.

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