Book Review

In the recent years Pakistan is plagued by a deep sense of mistrust and anger against the medical profession. This is mainly due to poor doctor patient relationship, for model healthcare used by the doctor, lack of adherent to principles of medical ethics, communication skills, counseling by the doctors, awareness of the psychological, anthropological, social and cultural aspects health and disease and the peculiar needs of patients suffering from various diseases.

It is the lack of understanding and training in these very areas on the part of the doctor that leaves him in tangles and wrong-footed in his interaction with patients, their families and the societal institutions such as media, police, judiciary and bureaucracy, unfortunately, the traditional curricula of undergraduate and postgraduate education and training of doctors as well as the exponents of these curricula, till late have been oblivious of these crucial aspects of a standard medical syllabus.

Behavioral sciences is the discipline of medicine that deals with the all important aspects listed above that are required to be integrated into ‘Health Care’ to restore the trust of the society in the medical profession and thus save the grace. The book titled “Integrating Behavioral Sciences in Healthcare” by Dr. Asma Humayun and Dr. Michael Herbert is a brave and timely attempt to provide academic text to health professionals in a crucial area of medicine, while “Pakistan Medical and Dental Council” have been recommend the teaching of behavioral sciences at the undergraduate level the attempts at implementing the recommendation have been cosmetic. Supported by the Higher Education Commission Pakistan, the two authors have put together a well written, and an evidence based book on the subject of Behavioral Sciences. On technical grounds, the two mental health professionals have used their vast experience to provide adequate material needed by a healthcare provider to improve upon his or her attitudes and affective domains of learning. Dr. Asma Humayun is renowned and a well respected psychiatrist, who practices in Pakistan while Dr. Michael Herbert is a Behavioural Scientist working in Malaysia, both trained in the UK. The backgrounds of the two authors thus serve as a great advantage to them to put together a text that links western medicine, local realities and the wisdom of East.
The book starts with a well written and a local rationale of using a biopsychosocial model of health care in preference to the traditional biological model. This prelude is followed by chapters on “Communicating Better” and “Medical Ethics” not in this order, but the contents address the two most crucial gaps in health care in our country. The chapters use local examples and case studies to help the reader relate to the content. Crucial area of steps to be followed in breaking bad news, provision of informational care, and emotional and normal psychological reactions amongst individuals in distress have been dealt with adequately in the first chapter. Similarly the chapter on ‘Medical ethics’ addresses controversial and contentious issues like ‘dealing with pharmaceutical industry’, sexual boundaries, training and research, and relationship with colleagues. The recommendations made are balanced, prudent and adhere to the highest traditions of the medical profession. These two chapters are also the best chapters of the book. The text in chapters on ‘Human Development’ and ‘Social influences on Health Care’ could have left a deeper impact with a lesser gender bias that betrays the examples cited and an opinionated rather that an objective scientific approach of the authors. The text on ‘Stress’ on Stress’ could have been included elsewhere (e.g. Mental Health Care’) for it breaches the flow of the chapter. Similarly the authors could have taken onboard the experience of local practioners and specialists in the fields of general medicine, cardiology,, and pain to enhance the relevance of the study of “Psychosocial Aspects of Physical illness”.
The chapter on ‘Mental Health Care’ is again rich in evidence and scientific study of the subject and makes incisive and level headed recommendations that can greatly help the general health care professional in making rational choices and early referrals, dealing with the mentally ill. The subsections on prevention of mental illness, promotion of dealing with the mentally ill. The subsections on prevention of mental illness, promotion of mental health and early recognition of mental health problems are well written, simple to understand and most enlightening to read. The section on mental health legislation may be more relevant to the mental health professionals but provides a doctor from another discipline, a chance to have an insight into the challenges that psychiatrists and psychologist face while dealing with the challenging world mentally ill.
The excellent and fairly current list of references at the end of each chapter is refreshing and adds to the scientific value of the book. An ‘Index’ has added to these attributes further.

All kudos to the authors for providing a reference book on a crucial area in health care, and thus filling yawning gap in our practice of medicine. The medical profession of Pakistan should therefore, thank the two authors.

Lt Gen Mahmood Ahmed Akhtar
Emeritus Professor of Medicine
6th January 2011