J Pharm Pharmaceut Sci (www.cspscanada.org) 10(1): 51-52, 2007
Minor Illness or Major Disease? The clinical pharmacist in the community
Editors: Edwards, C. and Stillman P., 4th Edition, Pharmaceutical Press, London, UK, 2006. p 268. (Price $49.95 Canadian.)
The book is written from the perspective of a pharmacist and general practitioner working in the United Kingdom Health Care System, most likely in a community setting. This area of practice is particularly challenging, as patients often present with generalized symptoms, but without a specific diagnosis. The purpose of Minor Illness or Major Disease? is to provide the pharmacist with a reference that will help determine whether self-treatment or a referral is most appropriate for presenting patients. This book is designed to help differentiate between a serious and mild condition, not the management of these conditions.
The book is divided into two parts, Part A: Responding to Symptoms and Part B: Preventative self-care. In Part A the first chapter is a general overview of basic concepts in pharmacy, including self-care and the process of obtaining a medical history. There is a wide range of topics, including cough and cold symptoms, gastrointestinal complaints and skin disorders. Part B focuses on preventative health topics including smoking cessation, cardiovascular disease, emergency hormonal contraception, and travel health. The chapters in Part A do not include preventative health information, but focus on treatment.
Chapters are easy to navigate, with significant colour contrasts, tables, diagrams, and summary boxes. The headings provide appropriate structure and are self-explanatory (e.g. ‘Second Opinion’).
Content is separated into short paragraphs. The book is written at an appropriate level for all pharmacists and pharmacy students, as the language is not overly technical.
Each chapter provides a basic summary of signs and symptoms associated with particular conditions. There is also a brief description on how to assess the patient presentation. There is a brief description of management of each condition, and then a section titled “Second Opinion”, which is how a physician would approach a referred patient. At the end of the chapter there is a summary of the conditions that are known to be responsible for producing the main complaint, a table summarizing the main criteria that warrant a physician referral, and case studies, which put the information into the context of a realistic patient scenario. Some of the chapters include photographs that capture the presentation of conditions (e.g. conjunctivitis).
Although there are treatment recommendations, the therapeutic information is very limited. In some instances drug names are listed, but doses are not given. This missing detail can be viewed as an asset for a community pharmacist in a hectic practice setting, but may be a limitation for other clinicians.
The main advantage of this textbook is the detail and depth offered in characterizing the signs and symptoms of particular conditions. This resource goes into more depth on referring criteria than most other literature written for pharmacists in a community setting. The photographs are especially valuable to provide a visual cue to identify conditions that require a referral. Case studies at the end of each chapter provide a realistic context in which the content of the chapter is applied, a very useful learning tool.
There may be some limitations for pharmacists using this textbook in settings outside the United Kingdom. Drug names, such as paracetamol rather than acetaminophen, are used. Also, the book will refer to treatments that are over-the-counter, but not available or only available on prescription in Canada (e.g. flurbiprofen lozenges, theophylline containing cold medications). Part B appears to be somewhat out of place, since the focus of the book is on treatments and referrals for common complaints. The smoking cessation chapter is helpful, but does not seem to be in line with the authors’ stated purpose of the book. Canadian pharmacists may be more familiar with using a resource such as Patient Self Care, which provides algorithms for referring criteria and also provides adequate treatment information.
This is not designed to be a text when a topic is unfamiliar to the pharmacist. The information is up-to-date and consistent with referral guidelines used in Canada. Overall it is a well written and well designed book on handling challenging patient presentations in a typical community practice setting. Pharmacists would benefit from having such a reference on hand.
Natalie L. Lutzak, B.Sc.
Cheryl A. Wiens, B.Sc.(Pharm), PharmD
Faculty of Pharmacy & Pharmaceutical Sciences
University of Alberta