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Travels of a Doctor — A Medical Drive through the EU.
Gerald Michael Troubadour Publishing: Leicester. 2009. p. 296£9.99 ISBN: 9781848760271.
We take much about our healthcare system for granted; it's always been like that, and we never think it might be different. The best way to challenge these assumptions is to look at how things are done elsewhere, but it's surprisingly hard to find out. I've had huge problems finding material on different healthcare systems for MSc students. It's not usually in academic papers, and the websites of health systems are designed for those working within the system, who also take much for granted. The same is true of the UK. When I was involved in Russian healthcare reform, the only way to explain the UK system was to write my own account.
This book therefore looks useful. The author visited GPs in all 25 countries of the European Union, asking them about their work and how it is organised. He is a recently retired GP, not a professional academic, and his tale of how little support someone with a interesting idea received from academic primary care is disconcerting (although the RCGP comes out fairly well!). He describes his work as qualitative research, gives a clear account of his methodology, and includes his topic guide for semi-structured interviews as an appendix. He recognises that, with only one informant in each country, his findings may not always be reliable or generalisable; his sample is neither purposive nor does he achieve saturation.
Despite these limitations, his tour throws some interesting light on the variety of general practice in Europe. The book has three parts; an introduction, chapters on each country visited, and discussions of key themes explored with information about the nature, organisation, and scope of their practices.
The chapters on planning the tour were interesting, and his chatty style was a refreshing rather than inappropriate change from traditional methodology sections (I particularly enjoyed his comparison of the RCGP Yearbook to the Beano!). He writes with an amusing wit. I was, however, disappointed with the chapters on each country. Instead of a summary of the interviews, enabling us to hear each informant's voice, perhaps set in the context of a travelogue, we get rather more travel details than we need, and bare details of the interviews. This part is essentially a travel book; bedside rather than academic reading.
The thematic chapters tell us much more about general practice across the continent, but of course he selects illustrative examples from a few countries — discussing all 25 each time would be unutterably tedious. However, summary tables based on his topic guide would be useful, so that one could see whether each country has gatekeeping, how primary care is funded, and how certification is handled.
Despite these limitations, most readers will learn something useful from these chapters. As the author points out, understanding practices in other countries not only gives us a perspective to critique our own healthcare system and how it might be improved; it also helps us understand the expectations of patients from abroad on the organisation of care, which can otherwise lead to misunderstandings. And this book offers a quicker way to do this than visiting 25 countries!