Medical Management of Vulnerable and Underserved Patients: Principles, Practice, and Populations, by Talmadge E. King, Jr, MD; Margaret Wheeler, MD; Andrew Bindman, MD; Alicia Fernandez, MD; Kevin Grumbach, MD; Dean Schillinger, MD; and Teresa Villela, MD. New York: McGraw-Hill; 2007. 454 pages, paperback, $39.95.

Healthcare practitioners must be equipped to meet contemporary holistic challenges that complex patients present. Particularly rooted in vulnerable and underserved populations, these complexities demand that practitioners possess "core principles and skills" toward resourceful patient care. Clearly, members of populations such as homeless, immigrant, mentally ill, substance abusers, gay and lesbian, or HIV-infected persons face barriers (eg, accessible services, cultural/language considerations, insurance/economic status, disability, educational level, age, inadequate transportation, homelessness, etc) that frequently preclude healthcare. Practitioners seek to better understand these populations, deliver services, educate patients, promote medical adherence, and effect behavior changes. The text was written for students and residents, yet it easily holds valuable information and guidance for all healthcare practitioners. Its intent is to inform readers about specific populations, general/family medicine, behavioral approaches to disease, and healthcare policy.

Part 1 (Principles) presents chapter topics such as healthcare disparities overview and application to vulnerable/underserved populations, finance, legal issues, and ethical care. Part 2 (Practice) presents chapter topics such as context for intervention, behavior change, medical adherence, cross-cultural communication, patient education, home/mobile outreach, group visits, interactive technology, quality improvement, case management/multidisciplinary care, and health in community. Part 3 (Populations) presents chapter topics such as children, adolescents, family, elderly, living/environment, dying, incarcerated, homeless, immigrant issues, limited English skills, lesbian/gay care, psychiatric illness, women's health, intimate partner violence, obesity, chronic pain management, substance abuse, tobacco use, dental care, chronic disease, disability, human immunodeficiency virus/acquired immunodeficiency syndrome, social complications, practitioner self-care, and advocacy. In all, there are 41 concise chapters written by physicians, nurses, social workers, lawyers, and dentists.

Chapter 6 "Creating a Context for Effective Intervention in the Clinical Care of Vulnerable Patients" emphasizes building a therapeutic alliance, eliciting the patient's story, and assessing/acknowledging psychosocial vulnerabilities. The text discusses therapeutic relationship elements (ie, trust, empathy, respect, agreement/collaboration, and extension). In particular with vulnerable patients, a therapeutic alliance can build empowerment and reduce barriers to care. The Core Competency is "Eliciting the Patient's Perspective." Chapter 24 "Care of the Homeless Patient" discusses definitions, causes/known risk factors, health status, healthcare system, history taking and physical examination, health promotion/disease prevention, medication, care plan, and strategies to address homelessness. The Core Competency is the "Institute of Medicine Recommendations for Addressing Health Care Disparities General Recommendations."

The textbook is very user-friendly. The chapter formats have learning objectives, brief scenario, well-defined headings, illustrative figures and tables, conclusion, key concepts, discussion questions, resources, and references. There is a comprehensive index. Of note, Chapters 2-41 have an extensive Core Competency table that matches chapter content. For example, the Core Competency table "Tailoring Clinical Practice to Vulnerable Children" matches Chapter 17, "Underserved Children: Preventing Chronic Illness and Promoting Health." The Core Competency presents population groups, care content, care context, and care contacts. For Chapter 25, "Immigrant Health Issues," the Core Competency table presents "Taking the Immigration History."

Healthcare practitioners must educate and prepare themselves to meet the challenges that diverse vulnerable and underserved populations present. This textbook addresses "core principles and skills" that complex medical care demands. With its rich resources, it fills identified knowledge gaps with practical information to facilitate more resourceful holistic and contemporary patient care.

Dot Baker, MS(N), RN, CS, EdD

Associate Professor, Nursing, Wilmington College, Georgetown, DE