Book Review

Exploring Rural Medicine: Current Issues and Concepts

N Engl J Med 1994; 330:1024-1025April 7, 1994

Article

Exploring Rural Medicine: Current Issues and Concepts
By Barbara P. Yawn and others. 332 pp. Thousand Oaks, Calif., Sage, 1994. $49.95 (cloth); $24.95 (paper). ISBN: 0-8039-4851-4 (cloth)

When the reader grasps map and compass to begin the exploration of rural medicine promised by this new book, it is not clear what kind of voyage of discovery awaits. The subtitle, Current Issues and Concepts, suggests a book that delves into the organization of the health care system and hints at a discussion of the massive changes that will inevitably occur in the wake of health care reform. Although the book touches briefly on this issue in the introductory chapter, the heart of the book is located in quite another continent: clinical care for particular problems or patient groups in the rural milieu.

Perhaps the focus on the clinical concerns of rural practitioners is not surprising, given the authors of this book: a family physician, a general internist, and a nurse, all with strong backgrounds in the provision of rural health care. I suspect that the topics addressed in the book reflect their enthusiasm and experiences, ranging from the prevention of teenage pregnancy to the care of terminally ill patients with cancer. This source of inspiration is both the book's strength and its weakness. The book deals with important problems and issues and is shaped by the real-world experience of the authors. But it provides neither a sharp, critical focus on a specific issue nor a comprehensive overview of rural health care or one of its components.

Exploring Rural Medicine is much like the 15-day prepackaged tour of Europe: it offers brief but fascinating stops in a variety of cities. The tour allows us to get a taste of the local cuisine, listen to the rhythm of a new language, and meet a few of the locals while we view some famous landmarks. But just as we could spend a month profitably in any of the countries we visited, so could any one of the discussions in this book fill a book of its own. For example, the discussion of environmental hazards provides brief case reports and addresses the problems of nitrite poisoning, lead toxicity, chronic exposure to asbestos, and arsenic poisoning. But what about exposure to pesticides among agricultural workers or the occupational hazards of farming? The discussion of adolescent pregnancy is an excellent summary of some successful prevention programs that have been evaluated. But where does the local doctor or nurse fit in, and why is the availability (or unavailability) of abortion in rural areas not even discussed?

I suspect that rural practitioners will enjoy picking up this book and comparing their approaches and insights with those of the authors. In areas such as the diagnosis of attention-deficit disorder in children, these readers may even pick up a few tips to assist them in their practice, although there is little in such a discussion to reflect a rural emphasis. The book will be of less use to the resident considering rural practice or the planner trying to design a more effective system. The visit to each domain is too brief, and the itinerary too erratic.

Roger A. Rosenblatt, M.D., M.P.H.
University of Washington School of Medicine, Seattle, WA 98105