Margaret Gerteis, Susan Edgman-Levitan, Jennifer Daley, and Thomas L. Delbanco; eds. 300 pages. San Francisco: Jossey-Bass Publishers; 1993. $29.95.

Patient dissatisfaction with the existing U.S. health care system has increased in recent years. The main outcries have been over issues of accessibility, affordability, and quality. Because the public is demanding a more active role in its medical care, health care professionals must understand what patients want and need. Through the Patient's Eyes addresses the issue of quality. Its premise is that understanding the patient's perspective and creating a more "patient-centered" hospital environment will enhance the subjective quality of care and increase patient satisfaction.

The authors draw on research conducted by the Picker/Commonwealth Program for patient-centered care, which included telephone interviews with more than 6000 recently discharged hospital patients and 2000 of their care partners. This information is supplemented by a review of the medical anthropology literature, informal discussions with health care professionals, and patient accounts of illness and hospitalization. The authors identify seven focus areas of special concern to patients: need for autonomy, coordination of care, better education, relief from physical discomfort, greater emotional support, more family involvement, and more extensive discharge planning and coordination of post-hospital care. They make suggestions about how hospitals can address these concerns.

The book is enjoyable to read and well organized and accessible to both medically and nonmedically educated audiences. The chapters, however, tend to overlap and cite the same references. In addition, it would have been helpful to see a copy of the questionnaire administered to patients and the specific results of the national survey. The work also lacks a broader historical context. The authors write about "hospital culture" as an observed phenomenon but do not address the growing body of historical literature, in particular the seminal works of Charles E. Rosenberg (The Care of Strangers: The Rise of America's Hospital System, 1987) and Paul Starr (The Social Transformation of American Medicine, 1982), that does much to explain the evolution of hospitals and their unique environments. Despite these shortcomings, the book is a valuable starting place for hospital administrators, health care planners, and medical educators concerned about improving quality of care.