Western Diseases: Their Emergence and Prevention

planning should be merely confined to just over 5 pages. The chapter on audio-visual aids, likewise, was too superficial to be more than an aide-memoire to the teacher already conversant with such means of communication. A number of chapters were concerned with various examination (used in the sense of assessment) techniques and methods but it was not entirely clear when the authors were specifically referring to the MRCGP examination and when to examinations in general. Fourteen of the 47 chapters were written by Marshall Marinker, Professor of Community Health in the University of Leicester, who is also one of the 3 editors of the book. Thirteen of these chapters were written in that easy but fluent and expressive style characteristic of him. The one chapter, no. 16 entitled 'Clinical Method', did not, in my view, fall into this group. I found it confused, confusing, unhelpful and misleading. To say that the intellectual processes occurring during a consultation in a hospital ward on the one hand and in a general practitioner's surgery or physician's consulting room on the other are different because the former takes longer and demonstrates the scientific method in clinical medicine whereas the latter is shorter and is based on pattern recognition and informed guesses misses the underlying principle whereby decisionmaking is arrived at in clinical medicine. I would also argue that it is not helpful for him to infer that clinicians in hospital (in this context, a teaching hospital) do not usually regard the patient as a person but merely as a vehicle to demonstrate some aspect of pathology (p. 24, in Chapter 4). No doubt this is true of some hospital clinicians, possibly even many but the truth of the matter is that they should be just as concerned in the patient as a person as any general practitioner. All in all I enjoyed reading this book but it tried to do too much with the result that too much of the ground was covered too thinly. S. E. JOSSE Adviser in General Practice, British Postgraduate Medical Federation, London.