Years ago, when I was the medical writer at the Sydney Morning Herald I undertook a short course that aimed to equip journalists with the basics of epidemiology. It was run by Professor Les Irwig, an epidemiologist at the University of Sydney, and his wife Judy Irwig, who were concerned about the way media reporting of health developments often misled the public.
I can still remember the sense of outrage that dawned as Les explained the dubious nature of the evidence base that then underpinned the widespread use of HRT as an agent for preventing heart disease in postmenopausal women.
This was back in the 1990s, and we now know how well founded his concerns were.
Judy talked about how fortunate she was to have an epidemiologist for a husband. While so many people found themselves drowning in a sea of often confusing and conflicting health information, Judy could turn to Les to help her evaluate health advice. Often, she was surprised to discover that so much of what people were being told, whether by the headlines, friends or health professionals, was misplaced.
And so the idea was conceived for a book to help share the tools for assessing health information. Smart Health Choices: Making Sense of Health Advice was first published in 1999.
Thanks to Associate Professor Lyndal Trevena, a Sydney GP and academic at the University of Sydney, this edition was recently updated, and Hammersmith Press published a new edition last year in the UK and Australia.
But we’ve always been conscious that the Internet is the best medium for spreading health information, and are delighted that Hammersmith Press recently gave us permission to take Smart Health Choices online.
You can now download it all here, through a Sydney School of Public Health website. (If you prefer the conventional book format, that option is also still available.)
I asked Les which bit of the book he likes best. He chose the five key questions that it recommends:
- What will happen if I wait and watch?
- What are my test or treatment options?
- What are the benefits and harms of these options?
- How do the benefits and harms weigh up for me?
- Do I have enough information to make a choice?
He says: “Having started off thinking it would be a book on how to look at evidence, it was only later that the penny dropped. The major issue was the structuring of the important questions to ask when making a decision. If one gets that right, that’s a long way towards getting the best outcome for the user. One only needs to dip into the evidence if the decision is not clear-cut, and asking the questions will clarify what is critical – what further evidence is needed.”
We’ve always hoped the book will be useful for general readers grappling with health decisions, and also for teaching, whether medical students, nurses or other health professionals.
Here is what one user has to say about the book. Dr Tim Senior, a GP at Tharawal Aboriginal Corporation (an Aboriginal Community Controlled Health Service) in Campbelltown, South West Sydney, who also teaches medical students and GP registrars, has recommended the book to family members as well as colleagues.
He says: “I would recommend this book to medical students and doctors for two reasons: One is as a simple how-to guide of practising evidence-based medicine. The other, perhaps more important, is as a guide to the sorts of questions their patients will want answers to, something doctors can get wrong very easily. However, the group I would recommend this book to most is our patients. If large numbers of patients come in to see their doctors, nurses and other health professionals clutching this book, and asking the questions it suggests, I can think of no stronger driver to consistently improving the quality of care than that. The main use of this book will be in really helping shared decision making happen in a consultation. At the end of the day, people need to be happy with whatever decision they have made, and this will only come about when they are participating in this, rather than being told what to do.”
Of course, the Internet is a two-way tool. It’s not only handy for disseminating info, but also for soliciting feedback. So if you have any feedback or critique of SHC, please speak up. (This is NOT an offer to provide health advice or to answer personal health questions. But it would be helpful to know what you like, or don’t like, about the book.)
Post Script: Apologies if this all seems like an outrageous self-plug. My only excuse is that I thought Croakey readers are probably more likely than most to be interested in such matters…