Medicine and multimedia: Urinary Disorders and Male Health: A Decision Making Guide for Patients
Authors: Trevor Gibbs
Journal: BMJ (1998)

With information technology now commonplace, it was inevitable that such technology should reach patients’ waiting areas. With the increasing awareness of health issues, patients expecting or demanding detailed insight into their health or disorder, and anything to do with health occupying prime time television, what could be more appropriate in a waiting area than an interactive CD player providing medical information? The difficulty is standardisation.

Patients are individuals and can bring to their consultation a host of psychosocial variables that are not evident until explored. Patients are of varying intellectual ability and live and work in different environments and cultures. Doctors, too, are individuals. Even with shared care programmes, protocol management, evidence based medicine, and clinical audit, they are still individuals with individual thoughts, ideas, and plans. The rapidly changing face of medicine, the increasing range of drugs, surgical tech-niques, and non-invasive procedures do little to improve our ability to standardise care.

It becomes frighteningly difficult then to design an information CD, suitable for inclusion into any patient waiting room, that will suit all needs. Urinary Disorders and Male Health attempts to provide information on urinary symptoms, from prostatitis to prostatic cancer, from infections to bladder tumours. Designed exclusively for male patients, it aims to fill in the gaps that the doctor forgot or was too busy to tell. A real need.

With extremely effective graphics and soothing background music, it makes the mistake of trying to tell everything. It moves comfortably from very basic anatomy to complex staging of bladder cancers, from the aetiology of bladder tumours to microwave therapy for benign prostatic hypertrophy. Unfortunately, it assumes that its audience is conversant with medical terminology and freely uses words such as hyperplasia, transitional cells, and carcinoma in situ.


The need for information if you are about to undergo a total cystectomy is not in dispute, and the CD handles this well. However, a patient asking you for a Mitrofanoff procedure may not be expected. 


BOOKCASE


Dick-Read’s Natural Childbirth was published in 1933. Its plangent criticism of current obstetric practices made the author few friends among the “O&G” establishment. But many women saw his contribution to the reshaping of medical attitudes to childbirth differently. In Post-war Mothers. Childbirth Letters to Grantly Dick-Read, 1946-1956 (University of Rochester Press, £35, ISBN 1 878822 87) Mary Thomas has collected letters he received from anxious women and his invariably courteous responses.


We hear a lot about obesity, leptin, and neuropeptide Y but not much about the process of ingestion of food. The Scientific Basis of Eating (Karger, $190.50, ISBN 3 8055 6498 8), volume 9 in the grandiloquently named series Frontiers of Oral Biology, is about how we smell and taste, chew, and swallow and the way in which these activities are integrated by the nervous system. It’s really for the specialist, but many will be interested in Edmund Rolls’ chapter about gustatory and olfactory processing in the brain and the control of eating. The concept that there are only four prototypical tastes—sweet, sour, salty, and bitter—is under attack. It seems that there are separate cortical representations of at least two other taste qualities—umami, the flavour of monosodium glutamate that is present in proteins from various sources, and tannin, the astringent taste found in a large range of spices, wines, and, of course, tea.


Disabled people and those who advise them will find Furniture (The Disability Information Trust, £10.00, ISBN 1 873773 15 3) invaluable. It’s an illustrated catalogue of beds, chairs, tables, and other equipment specially made for people with disability. Not only does it provide detailed information on the equipment that is available, it also gives advice on where and how to get it.


Murphy’s law states that if anything can go wrong it will. To minimise the effects of this law, the pharmaceutical industry uses standard operating procedures, defined as detailed written instructions to achieve uniformity of the performance of a specific function, in the conduct and reporting of clinical trials. Good Clinical Practice. Standard Operating Procedures for Clinical Researchers (John Wiley, £29.95, ISBN 0 471 96936 2) is a compilation of checklists. Anyone concerned with clinical research, especially trials of drugs and medical devices, might find that it saves them a lot of time.


The level of medical and anatomical knowledge of the ancient Greeks was unsurpassed in Western culture until the 16th century. In Greek medicine. From the Heroic to the Hellenistic Age. A Source Book (Duckworth, £14.95, ISBN 0 7156 2771 6) James Longrigg provides a selection and translation of some of the most interesting classical texts.Christopher Martyn, BMJ







All is not lost, however. Despite its limitations, this CD will be of use to doctors. Its thoughtful and up to date presentation of the diagnosis and management of urinary problems will provide general practitioners and junior hospital doctors with the answers to all those difficult questions that patients ask after seeing the consultant or, more commonly, after seeing a television programme the night before.