Dr. Lesley Morrison
Cell 2 Soul. 2005 Winter; 1(4):a12
Patients tend to like to leave the surgery with a prescription in their hand. But the prescription does not need to be for drugs. For 9 months we have been running a scheme whereby we can "prescribe" a book.
A project had been running in Cardiff for some time based on work done by a clinical psychologist who had validated a list of books useful to patients with mental health problems. I discussed it with him and, yes, he was more than happy for the list to be used elsewhere. The Borders Healthy Living Network, an arm of health promotion with lottery funding, was interested as was the local librarian who accessed council funding. We produced a pack with the book list, including a brief synopsis of books' contents, prescriptions and evaluation slips. A rather fine logo depicting a drug capsule split open with books pouring out was devised and appears on all the materials including on the book spines. The books are held in the health section of the library, available to anyone who wishes to borrow them. Someone who is not a member of the library but presents a prescription is equally entitled to borrow. The deliberately simple evaluation slips are in the form of a bookmark and anonymous. They ask whether the book was useful and whether the reader would recommend it someone else and use smiling, neutral and frowning faces to record responses. Library staff point out the bookmarks to customers when they borrow but ask no questions about the reader's reasons for borrowing or reactions to the book.
The issues covered in the alphabetical list are anger, anorexia nervosa and eating disorders, anxiety, assertiveness, bereavement, bipolar disorder, depression, gambling, health anxiety, obsessions and compulsions, panic, post-traumatic stress disorder, self-esteem, sex abuse, sexual issues, social phobia, stress and worry. Lists, and prescriptions, have been provided to GP's, practice nurses, community nurses and health visitors.
How successful has the scheme been so far? As with all such innovations, it has taken a while to get established and numbers of books borrowed have been less than anticipated. Numbers of prescriptions offered have also been less than we had imagined. Perhaps this is due to the introduction coinciding with the challenges of the new contract? Some concern was expressed by GP's at the beginning about recommending books about which they know little. Obviously "prescribers" tastes will vary (as will readers') and, as with drugs, people will develop their personal favourites and will be more likely to prescribe books that they have read or, at least, skimmed. They will choose a book with a style and reading difficulty to suit the patient. A potential side-effect is the embarrassment and alienation risked by offering a book to someone afflicted by illiteracy, as are many more of our patients that we commonly realise. Verbal feedback from patients who have taken advantage of the scheme has been very positive but, interestingly, very few evaluation slips have been completed perhaps reflecting a concern about confidentiality.
Whither now? We have just been offered further funding to expand our range of books and are currently canvassing opinion about which topics would be most useful. Palliative and cancer care, parenting, the menopause, adolescent health and men's health have been suggested. We are going to produce a list of useful web-sites to display alongside the computers in the library. Initially, we were reluctant to publicise the scheme in case a flood of patients requesting "prescriptions" resulted but we are now about to produce leaflets and posters, and to spread the word to schools, clinics and the occupational health department. We continue to take care that the scheme is not perceived as a cost-cutting alternative to GP consultation time or to referral for psychological or psychiatric input. It is an adjunct. But, we believe, a useful and valuable one.
Reprinted with kind permission from Hoolet: The magazine of the Royal College of General Practitioners in Scotland.