Brain, Vol. 122, No. 3, 584,
March 1999
© 1999 Oxford University Press
Book Reviews |
PROGNOSIS IN NEUROLOGY.
Edited by James M. Gilchrist. 1998. Pp. 473. Oxford: Butterworth Heinemann. Price £55. ISBN 0-7506-98888..
Medical Services, Western Bay Health Private Bag, Tauranga, New Zealand
One of the fundamental roles of a neurologist is counselling patients about their future, for both diseases for which treatment is available and those where none exists. Diagnostic skills are acquired early in training and, with time, can be delegated. However, depth of experience is a prerequisite for accurate, informed and sensitive advice about prognosis. The preface to this book claims that the success of modern medicine includes its scientific foundations and advances in treatment, but that the physician's role in prognosis, of great importance to our patients, has been `sadly neglected'. Whether you agree with this perception or not, the editor has assembled a multi-author volume of neurology with an emphasis on prognosis.
Prognosis in Neurology is presented as more than 400 pages of hardbacked text, covering 81 conditions in individual chapters, with 94 contributing American authors—a credit to the organizational skills of the editor. As well as those disorders in which natural history and prognostic studies have been extensively studied (e.g. stroke, multiple sclerosis, amyotrophic lateral sclerosis), the book covers such conditions as metabolic encephalopathies, cerebral palsy, alcohol withdrawal, migraine and even toxaemia. These less commonly encountered conditions are areas in which the book may prove most useful to neurologists.
Chapters follow a similar layout, beginning with a definition and presentation of the disorder, followed by evaluations important to prognosis; a discussion of the course of the disease; factors affecting outcome; short- and long-term prognosis and effects of treatment. The result is a small textbook of neurology, with a strong emphasis on prognosis. The data are up to date in those areas where therapeutics have recently changed. The style is relatively informal, even chatty, with references limited to a few per chapter and not annotated within the text.
There is a sense that the editor aimed for comprehensive coverage of neurological disorders, perhaps at the expense of detail, providing a useful overall impression rather than in-depth analysis of individual items of scientific data. Much of the information included is available in the larger textbooks of clinical neurology. I feel the book would have been considerably enhanced by including at the outset a review of the epidemiological methods, tools and definitions common to the study of prognosis. The chapters could also have indicated more systematically, perhaps in tabulated form, an assessment of the quality of data on which the prognosis is based, as this varies enormously between conditions.
In a world of information overload my initial reaction was that this book re-presented data already widely published, albeit with a novel slant. However, after using the book in clinical practice for a few weeks, I found it helpful as a readily accessible, focused resource with direct relevance to patient care. The book is also likely to be useful as a reference for reports to third parties.
Whilst undertaking this review, a woman with multiple sclerosis reminded me that in 1985 I had answered questions about her future ability to walk in terms of the likely need for a wheelchair within a few years. The prognosis was correct but she recalled how upset she was at the time with this outlook. Dr Gilchrist has compiled abundant information about prognosis, but ideally a book of this kind should also help us with the psychology and process of sharing (often) distressing news with our patients. In the clinic and wards in fact, we may attempt to tailor the prognosis, particularly so as not to remove hope for the future, rather than necessarily conveying the facts and figures extensively researched for this book. Knowledge of prognosis is an essential side to the equation but the real challenge remains to provide our patients with prognostic data honestly but sensitively.
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