'Nothing matters very much, and few things matter at all' - Arthur Balfour, Conservative Prime Minister 1902-05

Over the past couple of years, I put together a book which................well, the following extract from the preface will tell you what I hoped it would achieve:

I wrote this book for a number of reasons:

Ø  To tackle the public misunderstanding of the principles which underpin    medical diagnosis and treatment, and to put across the concept that    those processes are often not a straightforward as patients like to imagine.

Ø  To counteract some of the sensationalist and inaccurate coverage that medical practice and the medical profession receive in the media.

Ø  To convey what it feels like to be a doctor in 2012, and to explain some of the challenges and frustrations which face us, and which affect our relationship with patients.

Why do I think that any of this matters? It matters because the doctor-patient relationship is important, and depends on a degree of mutual understanding. That understanding is put at risk by unrealistic patient expectations, which are increasingly fuelled by politicians who view the NHS as a problem to be contained within their 4 or 5 year timescale, and by media whose correspondents lack the necessary understanding of the scientific principles mentioned in my first bullet point above.

I have written unashamedly from a doctor’s perspective, because that’s what I am, and it’s the medical point of view that I’m seeking to explain. But I’m also a patient (more often than I would like in recent years), and I also meet a lot of you in your role as patients, so I hope I know a bit about what it feels like to be on the other side of the consulting room desk.

This is what the advertising blurb says (and it must be right - I wrote it myself):

Have you ever wondered why doctors use drugs that have side effects, or been tempted to respond to the adverts coming through your door for private health checks? Do you wonder why many (but not all) doctors think homeopathy is a waste of NHS resources, and do you sympathise with the tabloid outrage every time a patient develops cancer despite being ‘given the all-clear’ after a screening test the previous year? Are you alarmed, as one politician was, by the fact that half of the surgeons in the country are below average when their performance is assessed? Do you still worry about allowing your children to receive the MMR vaccination?

These issues, and many others, are addressed in this book. It is written by a doctor who is concerned that the failure to explain the principles underlying medical practice is beginning to undermine the doctor/patient relationship, aided and abetted by media and politicians who are equally ill-informed, and too interested a good story or the result of the next election to bother to educate themselves.

He describes what it is like to be a doctor in 2012, working in a rapidly changing environment where all the old certainties are being swept away. While most patients still trust their doctors, that trust is increasingly tempered by suspicion, fuelled by examples of the damage that can result when today’s powerful medical and surgical interventions apparently go wrong, or are misapplied by negligent doctors.

The book attempts to allay some of that suspicion by explaining how it is possible for things to end up badly even when the doctor does everything right. It also encourages a more realistic approach to the assessment of risk, explaining, amongst other things, why we can never prove that any treatment is 100% ‘safe’.

In addition to explaining how diagnostic and treatment decisions are made, the book covers difficult areas such as medical confidentiality, alternative medicine, and the potential conflict between private practice and NHS work. It doesn’t dodge the issue of poorly performing doctors, although the GMC gets the rough edge of the author’s tongue.

The book is aimed at patients (i.e. all of us). The style is unashamedly opinionated, intermittently humorous and occasionally politically incorrect. The important chapters dealing with evidence, risk and the medical approach to uncertainty will hopefully assist readers as they struggle to understand  the diagnostic and therapeutic process. The rest of the book will help them to make sense what is going on in health care in the early years of the 21stcentury.

It should (but probably won’t) become required reading for journalists and politicians.

It's a snip at $3 (£1.99) on Amazon, so go on, give it a go. At the time of writing, it's 350,000th in the Amazon best-seller list, so I could do with a bit of help - you'll find it HERE.

Finally, here's the first few paragraphs from chapter one, just to give a flavour:

It has never been much fun being a patient, although it was a lot harder a hundred  years ago, when even the best doctors had little to offer in the way of treatment beyond a plausible bedside manner and a bottle of leeches. But at least the role of patient didn’t require much thought. These days though, patients are assailed by the press on the one hand with stories about ‘breakthroughs’ and gee-whizz-isn’t-it-wonderful-what-they-can-do television programmes showing modern treatment advances in glorious close-up, and on the other by stories suggesting that doctors are a bunch of murdering, money-grubbing, incompetent wasters. The technology may be amazing, but walk into a hospital, the journalists say, and you take your life in your hands, and should count yourself lucky if you avoid being butchered, poisoned, infected or irradiated into an early grave.

And trying to stay healthy in order to keep yourself out of the clutches of the medics isn’t easy either. Few food items or lifestyle choices are safe: if today it’s touted as the key to a long and happy life, by this time next year someone will have identified it as a leading cause of cancer, liver failure or some horrible neurodegenerative disorder. In the course of just one week in 2007, The Times headlined moderate regular drinking as the curse of the middle classes, condemning them to premature death as gibbering, jaundiced wrecks, and then three days later told us that there wasn’t actually any evidence for the initial scare and that we could drink up to a bottle of wine a day and still be healthier than our miserable teetotal counterparts‒advice which many of us have taken to heart. Five years later, they have just told us that three glasses a week is a sensible maximum – advice which I, at least, intend to ignore.

So it’s beginning to feel as if you need a degree in health sciences to have any chance of playing your full part in the medical transaction. Because of course, that’s what it is these days ‒ a transaction. In those long-ago days of the twentieth century, medicine was something we, the doctors, did to you, the patient. Now you have to be actively involved in your treatment, whether you like it or not, and that pre-supposes a highly-informed patient capable of making life-changing (or possibly life-ending) decisions, working in tandem with your right-on, non-arrogant and not even slightly condescending doc. What’s a person to do?

Buy it and read on, if you want the answer to that, and many other questions.