Outside the hospital: the delivery of healthcare in non-hospital settings

By Don Griffin and Polly Griffin . Published by Jones and Bartlett Publishers , Massachusetts ( 2008 ). Paperback. 173 pages plus index . ISBN 9780763745042 RRP $81.95

Reviewed by Michael Montalto

Hospital in the Home at Royal Melbourne Hospital and Epworth Hospital, Melbourne, Victoria

The Griffins have produced a small book with a big task: to describe the panorama of outpatient services available to Joe the Plumber (aka the average US citizen). The book achieves the task much better tha n I imagined it would on first opening the cover.

It is aimed at consumers, students and newcomers to professional health practice, and policy planners. Think of this book as the ‘Dummies Guide to the US Outpatient Health System’. The authors don’t advance any overriding analysis of the system: it is primarily descriptive.

It is useful in several ways. Firstly, it has 32 chapters. It is a very broad view of the system, but with enough detail for the target audience. But for those of you who have read the detailed citation above, you’ll have worked out a mean of five pages per chapter. I have discovered that five pages is the exact length before which my attention on any technical subject fades and I start to tune out. The effect of five page chapters is akin to repeated small bracing slaps in the face, shaking you back to attention. Almost mockingly, each chapter ends with several self-check review questions. If you can’t answer them, you have Alzheimer's disease.

At the risk of sounding sycophantic, a working knowledge of the US health services is important. This book would be useful before visiting the US for study reasons, presenting at US conferences or moving there to live for a time. Reading US-based health blogs and journal papers requires an understanding of contemporary health organisation (even those pesky acronyms), and this book is very helpful. The vicarious blue state constituents among you might recoil, but I find the health blog of the Wall Street Journal to be an excellent and impartial source of policy news (http://www.wsj.com/health). Further, outcomes of experimentation in the US health system are soon on the agenda in Australia as a matter of course (see chapter 3, ‘The Doc in the Box’ among others).

A text like this also helps guard against what I refer to as the Washington-Stockholm Syndrome. This refers to the Australian tendency to accept second hand citation of how wonderful things are organised in Scandanavia and how terrible things are in the US, without the audience having a ready way of checking either situation. There clearly needs to be a companion text for Swedish outpatient services.

However, this book's greatest benefit is likely to be its greatest weakness. Rapid changes to health care organisation, to which the US is prone, will threaten the accuracy and contemporaneousness of this text.