Publisher: The Edwin Mellen Press,. Box 450 Lewiston, N.Y. 14092. Publication Date: 1985. Pages: 345. Price: $29.95. Counselling the family is an important.
Canadian Family Physician reviews books of direct relevance to family medicine. Other books received are listed periodically. Readers who
standing of the way in which individual behaviour and development are intrinsically enmeshed in one's own family of origin. The work provides would like to review books are an excellent review of the Bowenian invited to send a list of their special theory of family functioning, family interests to the editor. development and individual development. The practical examples help to simplify concepts that are often complex in definition. The multi-problem family is a challenge for the practitioner. In this chapter, Dr. Sawa characterizes these Title: Faimily Dynaimics for Phvsi- families and the common stresses that ciains.: Guideline.s to Assessment will be presented to the family physiaind Treatment cian. His review of the various apAuthor: Russell J. Sawa proaches (intensive case work, case Publisher: The Edwin Mellen Press, conference, community development, Box 450 Lewiston, N.Y. 14092 and primary-care approach) is a helpPublication Date: 1985 ful guide to common interventions. Pages: 345 Common pitfalls that physicians can Price: $29.95 fall into while helping a multi-
The Family in Family Medicine
Counselling the family is an important part of working with families in family medicine. In that regard, Russell Sawa's book is very important because it introduces this dimension of the practice of family medicine. The main strength of the book stems from the multitude and richness of the examples it presents. Each example is brief and highlights a specific problem or point to be illustrated. It is very easy for the practitioner to relate to any of these cases. The most interesting chapter, in my opinion, is the one covering the concept of connectedness: the person in relationship. Better than many books currently published on the family in family medicine, this chapter highlights the fundamental influences of the family on one's behaviour and development, as well as the relationship between the individual and the family, and the impact on roots on development. For most family physicians who deal specifically with individuals, this approach facilitates under942
problem family are emphasized. Problems faced by mid-life families with an aged member are discussed, as well as families with an elderly member. Such a family must cope with its own change in life cycle while, at the same time, meeting the demands of elderly parents. Practical examples provide the clinician with specific suggestions for assisting those families. The chapter on sexuality is brief and covers common problems presented by couples to a family practitioner. The clinician will appreciate the clarity of the instructions, placed in the context of an office setting. The chapter on family and illness describes very well the impact of illness on family equilibrium. In this chapter, Dr. Sawa describes the impact on various categories of his family-assessment tool: connectedness, life-cycle stages, intemal functioning, and health and coping: a good strategy to bring his model to life. Alcohol and drug abuse are not unusual problems confronting the family
physician. Dr. Sawa describes very well the link between family functioning and the maintenance of addictive
behaviour. His chapter highlights well the early detection and various family approaches in the management of an often very frustrating problem. While the clinician will no doubt very much enjoy the vignettes presented by Dr. Sawa to illustrate the concepts in each of the chapters, it might appear to be a little more difficult to understand the first chapters, especially Chapter 1 on family assessment. The family-assessment tool presented seems somewhat complex and unwieldy, and the chapter requires very careful reading in order for the reader to remain comfortable. I would like to suggest that the reader start with Chapter 3 and read through to the end. The first two chapters should, I think, be read last, since by that time the reader will understand the frame of reference and will be able to pull the whole book together. Though Dr. Sawa's book deals with common counselling issues in family medicine, it displays a definite weakness in omitting the counselling of parents on specific issues, such as behaviour or parenting problems. The chapter on divorce and reconstituted families summarizes current literature very well. However, it lacks a practical approach by not addressing specifically the common problems facing primary-care physicians: how to tell children about separation, visitation
rights, discipline, boyfriends/girlfriends, and other single parent issues.
To the teacher, this book offers very important resource material. The summary and questions for further group discussion, placed at the end of each chapter, can facilitate the teaching of concepts often foreign to residents. I have found that a number of very practical examples compensates CAN. FAM. PHYSICIAN Vol. 33: APRIL 1987
for the lack of clinical experience and add reality to group discussions. In summary, I find Dr. Sawa's book very exciting. The reader will enjoy the vignettes, and the book will definitely stretch the reader's understanding of the family in the practice of family medicine. Reviewed by Yves Talbot. Dr. Talbot is a Fellow of the Royal College of' Physicians of Canada, and a member of the active stff of' the Department of' Family and Community Medicine, Mount Sinai Hospital, Toronto, Ont.
The Profitability of Health Care Title: The Second Sickness: Contradictions of Capitalist Health Care Author: Howard Waitzkin Publisher: The Free Press, A Division of Macmillan, Inc., 866 Third Avenue, New York, N.Y. 10022 Publication Date: 1983 Pages: 282 Price: $18.50 The author of this book believes that it will be most discomfiting "to those who are least distressed by our present predicament". Waitzkin has written a scholarly and important critique of health-care delivery in the United States and other Westemr nations. The result is not merely a left-wing lament, but rather, a political manifesto, recommending strategy for change. The title is drawn from Norman Bethune, who also believed that social ills underlay much of the pathology seen by doctors. The suffering that physicians are asked to relieve may often have its source in broader social issues such as occupational settings, sexism, racism and unemplQyment. The suffering itself is often idnce of, and motivation for, social change. Easing this suffering without also using it as a focus for political change simply covers up the social problems. Waitzkin's solution is for physicians and other health-care workers to become social activists, putting patient interests ahead of their own professional interests. Waitzkin argues that the profit motives of the health-care industries and physicians' professional class interests have resulted in an oppressive medical system that discriminates against the CAN. FAM. PHYSICIAN Vol. 33: APRIL 1987
