BOOK AND MEDIA REVIEWS
work together in groups and introduce the five stages of change: initiation, reality, resistance, compromise, and integration. They challenge the current corporate leadership, top-down and autocratic, of most health care organizations and advocate replacing them with lean leaders, who are mentors and facilitators. If you are asking yourself what this has to do with improving patient care and medical practice then you will enjoy the action plan that identifies the quality crisis as the burning platform for all of health care. The authors make a convincing case that we cannot afford the cost of waste in health care. This book will take several hours to read but flows well and is worth the investment of time and money. For people interested in lean health care, the authors recommend visiting the Lean Enterprise Institute at www.lei.org, and those interested in changing health care service delivery visit Healthcare Value Leaders Network at www. healthcarevalueleaders.org. I truly enjoyed the ideas and suggestions put forth in this book and will give it as a gift to my current organization leaders to read and think about not if but when we will institute lean health care in our organization. Richard Backman, MD
Department of Family and Preventive Medicine University of Utah
Behavioral Medicine in Primary Care: A Global Perspective Julie M. Schirmer, Alain J. Montegut, eds Oxford: Radcliffe, 2009, 157 pp., $45, paperback
A number of years ago, a physician colleague of mine visited China as part of a health care delegation. Having an interest in behavioral health, she had many conversations with Chinese practitioners about their work. She recalls particular incredulity about the cherished Western notions of “self” and “selfesteem,” commenting that it was “utterly foreign” for people from a communitarian culture to give such priority to people’s individual wellbeing. 446
JUNE 2011 • VOL. 43, NO. 6
Her story illustrates some of the challenge of working with behavioral health and medicine issues in cross-cultural settings. How do you support the young Ethiopian mother whose family tells her that her infant’s congenital deformity was caused by an evil spell? What do you want to know about a middle-aged Vietnamese woman who presents with headaches and fatigue that prompt her neighbor to refer her for care? How can medical clinicians provide meaningful behavioral health care in places where there are little or no specialist behavioral health resources? Behavioral Medicine in Primary Care: A Global Perspective addresses these and other such challenges in providing respectful, effective, patient-centered behavioral health care for people of different ethnic and cultural backgrounds. The principal authors and editors are longtime family medicine educators Julie M. Schirmer, MSW, and Alain J. Montegut, MD, who collaborate with a strong collection of American and international colleagues. They first review the essential elements of Western behavioral medicine principles and approaches, including the biopsychosocial model, clinicianpatient communication, stages of change and risk reduction counseling, and family systems. The heart of the book, then, is their exploration of the way these principles and approaches can be applied in working with people of different health beliefs, community structures, and healing traditions. Particularly strong sections examine alternative ways of conceptualizing health and care and approaches to eliciting and working with patients’ explanatory models about illness causation and healing. There is also a fine chapter on practitioner wellness, which underscores the key idea that mental health is more than the absence of mental illness. Practitioners, accordingly, need to be concerned both about alleviating suffering and also about promoting resilience and well-being for themselves and their patients. Case examples complement the text well. Each chapter begins with one or more descriptions of patient presentations in cross-cultural settings and then follows these cases through to some resolution in light of the material that the chapters present. The chapters also conclude with helpful lists of key resources. I especially appreciated the tone and spirit of this book. A practitioner with Western biomedical sensibilities could easily dismiss cross-cultural explanatory models (eg, vital imbalances) and healers (eg, shamanic practitioners) as quaint and archaic vestiges of FAMILY MEDICINE
BOOK AND MEDIA REVIEWS
primitive societies. The book does not do this. Rather, it models respect and honoring of other people’s worldviews and recognizes that indigenous beliefs and practices may sometimes be essential elements of healing. The inclusive tone and spirit of this book is important and also timely. While reading this book, I was reminded of the 2010 book by journalist Ethan Watters on the Globalization of the American Psyche.1 Watters argues that the ways in which suffering is expressed and treated around the world are inextricably bound up in culturally based understanding of human nature and personhood. He gives compelling examples of Western frameworks for understanding mental illness and suffering having been “exported” to other cultural settings, not always with beneficial results. As this intriguing issue unfolds, Schirmer and Montegut’s book stakes out a position of cultural humility that should support an open and honorable conversation about healing between Western and non-Western practitioners. This book is a great resource for anyone interested in practicing in cross-cultural settings, but these are not the only readers who will find this book meaningful. After all, the 52-year-old, overweight, Anglo, diabetic woman from Palermo, Maine, has her own unique understanding of what values are important in her life, of what health and healing mean
to her, and of how it is that she can best work collaboratively with her primary care provider. We don’t have to travel globally to find medicine where culture matters. I do have one suggestion. The contributions of the international authors to all of the chapters of the book are merged with, and not separately noted from, those of the American authors. I think it would make a fascinating symposium to bring together the domestic and international authors of this book for a conversation about their respective experiences and views about health, healing, and behavioral medicine care. This is not a cookbook, because there are no clear and universal recipes. It is, however, a fine collection of ideas, templates, and practical approaches to cross-cultural behavioral medicine care. It will be a great resource for readers who bring their own curiosity, creativity, cultural humility, respect, and passions for healing. Frederic C. Craigie, Jr, PhD
Maine-Dartmouth Family Medicine Residency
References 1. Watters E. Crazy like us: the globalization of the American psyche. New York: Free Press, 2010.
Publishers who wish to submit books for possible inclusion in Family Medicine’s book reviews section should send texts to Cathleen Morrow, MD, Family Medicine book reviews editor, Dartmouth-Hitchcock Medical Center, Department of Community and Family Medicine, HB 7015, 1 Medical Center Drive, Lebanon, NH 03756.
[email protected]. Reviewers interested in writing reviews for publication should contact Dr Morrow as well. William E. Cayley, Jr, MD, serves as Book and Media Reviews Associate Editor. All books reviewed in this column are available for purchase at amazon.com through the STFM portal at www.stfm.org/bookstore.
FAMILY MEDICINE
VOL. 43, NO. 6 • JUNE 2011
447
