Minor Illness or Major Disease? The Clinical Pharmacist in the Community, 4th edn.

Reviewed by MD Reed1 As the book’s two authors note in the preface, this book originated from a series of articles they wrote and published between 1979 and 1981 in Th e Pharmaceutical Journal. Th e original series of articles was compiled and published as their fi rst edition in 1982. A second series of published articles and two further editions served as the foundation for this fourth edition. Th e authors—one a pharmacist, the other a physician— recognized early the strong desire of patients for selfempowerment with regard to their health care as well as the sustained, increasing trend among patients toward a greater dependence on self-medication practices. Within this same time frame, the education and practice of pharmacists were also undergoing a major transition, away from an emphasis on drug procurement and dispensing to the current role as a pharmacotherapy consultant and practitioner. Th is book targets the ambulatorybased clinical pharmacist, the health-care professional who is uniquely qualifi ed, but most importantly, the one physically located closest to the pharmacopoeia available to the patient for self-medication decisions. However, contemporary pharmacy training programs in many countries now include in their curricula much of what is provided in this text. Th e book consists of 20 chapters divided into two parts. Aft er introducing the reader to the concepts behind the book and the format common to each chapter, Part A examines 15 important disorders as either focused entities (e.g., “Headache,” Chapter 2; “Cough,” Chapter 3; “Constipation,” Chapter 6; “Diarrhoea,” Chapter 7) or disorders of systems (e.g., “Abdominal Disorders,” Chapter 8; “Ear Disorders,” Chapter 10; “Musculoskeletal Disorders,” Chapter 11; “Foot Disorders,” Chapter 15). Part B consists of four chapters: “Smoking Cessation” (Chapter 17), “Cardiovascular Disease” (Chapter 18), “Emergency Hormonal Contraception” (Chapter 19), and “Travel Health” (Chapter 20). Obvious from these chapter titles is the book’s clear focus on diseases affl icting the ambulatory patient. What makes it diff erent from other such texts is its focus on what truly is a minor disorder or disease that can be managed by the pharmacist and patient in the outpatient setting as opposed to when the disease process requires physician consultation or immediate attention. A common format is used for the chapters in Part A. Each is subdivided into seven major sections: “Introduction,” “Types,” “Assessing Symptoms,” “Management,” “Second Opinion,” a sparse bibliography, and a detailed chapter summary. “Second Opinion”—a new section for this edition—is intended to provide the reader with a “brief insight into the action the doctor might take when a patient presents for advice.” Refl ective of the book’s very practical and clinical perspective, the section “Assessing Symptoms” is further subdivided into a format that the authors describe as refl ecting a “system of questioning used by the medical profession to obtain a medical history that allows the pharmacist to decide whether the patient has a minor illness and can self-treat or whether there is a need to seek a medical opinion”—the premise of this book. Th e information presented in the chapter sections provides a brief review, oft en superfi cial, of the incidence, fundamental diff erential diagnosis characteristics, and symptom complexes associated with the target disorder. Overall, very useful clinical information is presented, and, true to the book’s intent, important physical signs and symptoms associated with minor illness vs. more major disease are emphasized. Unfortunately, the chapter section most likely of greatest interest to the readers of CPT (i.e., “Management”) will be of least utility to practicing clinicians across the healthcare professions. Th e drugs 1Department of Pediatrics, Case Western Reserve University, and Pediatric Clinical Pharmacology and Toxicology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio 44106, USA. Correspondence: MD Reed (mdr2@case.edu)