Book reviews

The new GMS contract rewards recording of clinician interventions in lifestyle risk factors such as smoking. A strategy, care protocol, and educational material is expected to accompany this activity, but if your integrity is at a low ebb you could just get someone else to tell your patients to stop, put the Read code on the computer, and still get your points. However, most professionals will genuinely want to help their patients make the changes that could reverse some of our major public health risks: smoking, alcohol overuse, and eating more calories than we use. We all know the impotence and frustration that we feel when met by a patient's denial or despair at their own (in)ability to do what we both know will be better for their health. So, how to maximise their chances of ultimate success is a key question for clinicians, which these books go a long way to answering.

Dr Rick Botelho is a practising GP and academic, who trained in UK but has practised in the US for many years. He brings a wealth of clinical and research experience to bear on this revised text, incorporating helpful summaries of recent psychological theories that most GPs will have missed in their original training, and a succinct but useful list of references to support his advice. The books are designed as a clinician's guide (1) and a patient handbook (2), with many individualised short exercises to allow both clinician and patient to reflect on their progress in analysing and changing lifestyle factors. These are supported by a website www.MotivateHealthyHabits.com, where the author will answer queries, additional support material exists, and details for purchase are available.

The theoretical basis of the books centres around the ‘six steps’ model (book 1, page 110–213), where the clinician and patient work through building their relationship specifically around a goal of lifestyle change: negotiating the agenda, assessing resistance and motivation, understanding where each is coming from in the relationship: then into planning and implementing change, and finally followup, and sticking with the patient for the duration of their hard fought struggles (or whatever). In seeing this as a step-by-step process, it makes lifestyle change compatible with other clinical agendas, but also fits in with the evidence that creating a climate for behavioural change assists patients to reach their goals.

What I like about the clinician book (1) is that it is user-friendly but evidence based: puts some firm responsibilities on the clinician to assist the patient, rather than absenting us from responsibility for such preventive measures: and shows that helping people change is much more complex than being nice and giving the facts. It particularly addresses childhood messages about eating, and seeks to make conscious the assumptions that both staff and patients are making around their attitudes to health. The patient book (2) has a wealth of options that you can tailor to your patients' needs, or lend them the book and allow them to pick and choose what works for them. It is highly evaluative, and commits us to an ongoing effort, just as we might use for more technical models of chronic disease management. After all, if we know that altered diet is key to diabetes, why not spend more time on this than the joys of routine blood or urine testing?

If it has any shortcomings, its style is somewhat in the North American cultural school of evangelism, and some of the brief dialogues about patient care are rather caricatured; but I say this only to forewarn, because it could be an excuse for cynical UK GPs to ignore its wisdom, and it is our pessimism that could actually undermine our patients in their efforts. Such details are minor when I compare it to other texts I have read on lifestyle change — which tend to be more theoretical, less reflexive, and much less applicable to daily clinical practice. I am using it with my patients, and they are enchanted by my genuine interest in their efforts to tackle their addictions. I am even using it to confront my own bad habits — well, intermittently but at least I am trying! Rick Botelho asks for feedback which is another impressive factor, as he genuinely wants to know if it works. Read it and see.

• © British Journal of General Practice, 2005.