BOOK REVIEWS682

(often Federal grant supported) dollars. These systemsoverwhelmingly fail to thrive once the initial grant runsout, because the mechanisms for reimbursement aremissing. The authors only mention this issue in passing,and provide much too little attention to this aspect.This is only one example of a number of areas in whichcritical issues raised in the published academic literatureare given short shrift.

Telemedicine and Telehealth is an ambitious work. Itseeks to provide an overview of an incredibly dynamicsector of the health care arena. It succeeds in injectinga refreshing clinical perspective into the debate. Itgenerally does not succeed in providing a broad

overview of the range of issues that rise to the top inexisting research. Despite the inattention to many im-portant issues and barriers, the perspectives it doesprovide are a valuable addition to the literature. Whentaken as part of a comprehensive reading of the litera-ture at large Telemedicine and Telehealth is worth ex-ploring.

W. DAVID BRADFORD

Center for Health Care Research and Medical Uni�ersityof South Carolina, USA

DOI: 10.1002/hec.597

Clinical Guidelines. From Conception to Use, edited byMARTIN ECCLES and JEREMY GRIMSHAW. RadcliffeMedical Press, Oxford, UK, 2000. No. of pages: 120.ISBN 1-85775-426-3.

Guidelines are now a commonly used tool in clinicalpractice and their number continues to increase. Validevidence-based clinical guidelines are seen as an impor-tant method by which to standardize practice andimprove the quality of care received by patients. Thisbook gives an overview of the methods of developingguidelines and using them in clinical practice. It isclearly written, concise and should provide a usefulintroduction to the topic. The editors should also becongratulated for making at least some attempt to givea balanced overview of the place of guidelines in clinicalcare. So although written by some of the leading propo-nents of guidelines, the book does give some discussionof their potential limitations and harms. However, withrespect to the actual methods of guideline development,little critique is made of the orthodox methods pro-moted in the book. The rigorous methods outlinedrepresent very much a ‘purist’ view of guideline devel-opment and little discussion is given to the opportunitycosts of using such methods.

There are other minor criticisms of the text. Somechapters in the book do not appear particularly usefulfor the generalist reader at whom such a concise text ispresumably aimed. For example, the chapter giving aninternational overview of clinical guidelines says littleother than that guideline production is increasing inmany countries and that some guidelines are more‘scientific than others’. In other chapters there is toolittle coverage of relevant issues, for example, whilesome mention is made of the desirability of assessingthe value for money of interventions recommended inguidelines there is little useful discussion about howeconomic data could be incorporated into clinicalguidelines. The chapter on using clinical guidelines isalso somewhat brief and would have benefited from afuller discussion of some of the strategies and ap-proaches that can be used to implement guidelines. As

pointed out in the book’s foreword by Sir DonaldIrvine (President, UK General Medical Council), imple-mentation is now seen as an increasingly importantaspect of guideline activity.

Against this, some chapters provide an excellentoverview of the issues they cover. For example, Hur-witz’s chapter on legal, political and emotional consid-erations provides a useful and interesting introductionto the issues. It answers many of the questions that areoften posed by clinicians asked to follow guidelines aspart of their clinical practice. Doctors in particularoften voice concerns about the medico-legal implica-tions of guidelines, especially with respect to negligenceclaims and the conclusions of this chapter will be ofinterest to many. For example, the chapter states thatalthough the Bolam principle (the legally required stan-dard of medical care a doctor owes to a patient. This isderived in the UK from the case of Bolam v FriernHospital Management Committee (1957) and is the‘standard’ of the ordinary skilled man exercising andprofessing to have that special skill) is presently comingunder pressure from a variety of sources, it is unlikelyto be superseded in the near future by a legal standardentirely determined without reference to a responsiblebody of medical practitioners.

Overall the book provides a useful introduction tothe person coming to the topic for the first time.However, while it gives an overview of the work in-volved in guideline development and implementation,there is insufficient detail for anyone who wants toactually take up an active development role. The bookalso gives little structured support for the person whowants to appraise the quality of a guideline. Neverthe-less, there probably is a need for a concise introductorytext and this book more than adequately fills that gap.

IAN WATT

Department of Health Studies, Genesis 6Uni�ersity of York, UK

DOI: 10.1002/hec.619

Copyright © 2001 John Wiley & Sons, Ltd. Health Econ. 10: 681–682 (2001)