Raphael N. Melmed, MD, Oxford University Press, New York, 2001, 410 pages, $51.00, ISBN 0-19-513164-9
Mind, Body, and Medicine: An Integrative Text is a fascinating text that interweaves the complex components of health and illness through scientific explanations, clinical examples, and real-world applications. It is designed to facilitate the reader's understanding of this vast literature.
This book is unique in its exploration of the psychosomatic aspects of medical practice from the viewpoint of a practicing physician, using information from a broad array of disciplines. It discusses the more commonly encountered complaints, such as stress, pain, and fatigue, that are routinely found (and largely untreated) in primary care.
The goals for writing this book were to provide a theoretical basis for understanding psychosomatic states and to discuss aspects of patient management unrecognized or largely ignored by medical practitioners. Given the author's extensive experience as an internal medicine physician with background in psychophysiology, the reader can see that these goals have been met. Melmed has also developed a clinical research program in behavioral medicine to supplement the material in this text.
The introduction provides an astounding account of the current situation of the healthcare system, in which 70%-90% of patients still treat themselves in lieu of seeking medical attention. Of the 10%-30% of patients who are seen by the healthcare system, only 50% will have a disease entity that can be classified and over 60% will have problems other than the initial complaint. One-third of patients will not comply with or use the advice or medication prescribed. Put into this perspective, it can be stated that "business as usual" in the American healthcare system is a rather poor business plan. As Melmed points out, imagine a company whose consumers discard a third of its market product before use.
Melmed describes a chronic disconnect between patients and physicians. This disconnect is rooted in the late 1900s with the revolutionary classification of diseases according to particular clinic features which led to the "systematic devaluation of the individually peculiar features of illness[horizontal ellipsis]" (p. 2). He makes a distinction between states of care and quality of the process of care, the latter of which is the focus of this book.
This text is exceptionally easy to read due to its interesting content and well-written style. It is broken down into 20 chapters, each building on knowledge gained in previous chapters. The chapters can also be read alone or in any order, though a comprehensive and fluid understanding is readily appreciated by reading it straight through.
Mind, Body, and Medicine: An Integrative Text is physician-centered in that it only takes the medical perspective into account. Melmed does not explore the literature related to nurses, nurse practitioners, or other healthcare professionals, who for some time have recognized the mind-body connection without requiring specific scientific support. Despite the excellent explanations and clinical examples, Melmed does not attempt a balanced approach by critically analyzing opposing literature. He states in the beginning that this topic has been largely ignored, yet there are many studies which question the efficacy of numerous "alternative" therapies. Ideally, this book should have discussed the merits and pitfalls of studies. As is, the reader is expected to take at face value the integrity of the studies presented or perform the critical analysis on one's own time.
Overall, it is an excellent book, which is highly recommended for any healthcare professional with an interest in a truly holistic approach to care. Nurses in particular will find that much of the information in this book will validate what they already know and have experienced in working so closely with patients and families.
nurse practitioner, Department of Neurosurgery, Jefferson Hospital for Neuroscience, Philadelphia, PA.