Field of medicine: Behavioral medicine.

Format: Softcover book.

Audience: Clinicians practicing and teaching in primary care specialties and trainees in these specialties.

Purpose: To discuss a wide range of psychosocial issues and problems facing the primary care physician and to suggest practical approaches to possible solutions.

Content: The text is divided into five sections that center on various aspects of the physician-patient-family relationship. The book begins with an examination of this relationship, which emphasizes physician insight and sensitivity. This is followed by several sections on specific types of patients with attention to ethnicity, sex, and age as well as patient compliance and self-destructive factors (for example, obesity, smoking, and alcoholism). Specific mental and behavioral disorders, such as depression and anxiety, are covered. Finally, a section addresses broad-based issues with particular topical relevance, such as death and dying, chronic pain and illness, and HIV and AIDS. Each section deals with a different aspect of the physician-patient relationship from a different perspective of effective physician communication and patient education.

Highlights: The book is cohesively edited and generally readable. Descriptions of techniques are bolstered by clinical vignettes that effectively cement teaching points without sounding contrived. The authors pay particular attention to the possible effects of managed care on the physician-patient interaction, and they make specific suggestions for dealing with the newer concepts of limited access to medical care and the generalist's role as gatekeeper.

Limitations: The text is broad-based and yet compact; it serves well as a guide but not as an in-depth analysis of any single topic. Because of its brevity, it is more a primer than an authoritative text and will probably suit trainees more than it does practitioners. In addition, some of the medical information is not current. For example, the list of medications for HIV-related disease is incomplete, no mention is made of the relation between newer appetite suppressants and pulmonary hypertension and valvular heart abnormalities, and the use of sustained-release buproprion in smoking cessation is not mentioned. Perhaps the book would have better served its purpose if it had omitted discussion of specific treatment methods and focused solely on approaches to disease states and behavioral aspects of primary care.

Context: This text is well positioned as an introduction for the physician-teacher and physician-in-training to the demands of the expanding role of physician as therapist. It serves as a springboard for more in-depth reading and as a reasonable resource for quick reference. Primary Care Psychiatry, edited by Knesper, Riba, and Schwenk (WB Saunders, 1997) is similar in content and format but also contains patient handouts and guides to self-help resources and organizations. Other available texts include Mental Disorders in Primary Care, edited by Miranda, Hohmann, Attkisson, and Larson (Jossey-Bass, 1994), and Psychological Disorders in General Medical Settings, edited by Sartorius (Hogrefe and Huber, 1990). These earlier books are not directed at the physician-in-training, are not case based, and are not as useful for quick reference. They do not address as well the expanding clinical role of the modern generalist who faces 21st-century issues, such as managed care and the limitation of resources.

Reviewer: David A. Horowitz, MD, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.