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Researching health care. Designs, dilemmas, disciplines

Although much lip service is paid to multidisciplinary research, few have put it into practice. In health services research, however, increasing numbers of attempts are being made to achieve this, often in spite of rather than because of the decisions of funding agencies. There is still a need for believers in the benefits of multidisciplinarity to argue their case with their principal opponents, who are often advocates of quantitative experimental methods. This book will prove a useful ally in that struggle. The book is based on a small international symposium held in Australia in 1989, which set out to debate the issues and establish a consensus on when and where specific methods of analysis are best applied for the effective evaluation of health care. Contributors include clinicians, epidemiologists, statisticians, sociologists, and economists. Apart from the final chapter, each contributor presents their view independently. Unfortunately no attempt is made to convey the flavour of any debate that took place. The reader is left to assume, whether rightly or wrongly, that few disagreements occurred. In a book full of interest, a few chapters stood out for me, though someone with a different background might well have identified others. Thus, the account of costutility analysis by JeffRichardson provided an excellent summary of the strengths and weaknesses of the method, and the three chapters on qualitative methods by Robert Dingwall, David Silverman, and the editors overcame a common failing by managing to explain to a proquantitative audience the value of ethnography and other qualitative methods. This initiative needs extending to convince policy makers of the practical value of such methods in the same way as, in this book, Jack Hirsh's chapter on the impact of quantitative studies on clinical practice does. The one puzzling feature was the contribution of Michael Jelinek, a clinician. While clinical medicine clearly has a legitimate voice in health services research, his chapter highlighted the difference in perspective between the two. This may have been a deliberate intention, though if so it was well disguised. Jelinek seemed to be unaware that such widely held views as the supposed decline in coronary heart disease deaths and the effectiveness of coronary care units have been seriously challenged. Curiously, what his chapter did achieve was to show the need for multidisciplinary enquiry into medical thinking, so in this regard its impact was consistent with the rest of this excellent book. My only disappointments were the failure of the editors to correct the misuse of the word 'methodology' by several of the contributors and the way the cover became detached from the book in the course of reading!