Maclaughlan M, ed. Librario. (Pp 122; £7.99). ISBN 0 954296087

A small book, this, but packed as full of meat as an egg. There is not a line wasted in MacLachlan's account of how patients face up to, go through, and recover from the experience of cardiac surgery.

What patients? A statistician might complain that there is no evidence in these pages of studies made by experts of carefully balanced statistically valid groups (including control groups, of course), no elegantly designed charts or tables—nothing, in fact, to add to any academic's collection of important texts. Just a lot of chat, really. Which is what makes this book so important. It is chat. It is an account of patients talking to each other, either directly or in quotes from letters, about their experiences of cardiac operations.

As I read it, it suddenly became intensely familiar to me. It transported me back to my years nursing on acute surgical wards, hearing my patients gossip to each other about their feelings and their past experiences and future plans, at the same time as taking care of their nervous bed mates by reassuring the anxious, helping the most ill by being suitably in awe of one who had had an unusual experience, and generally creating a sort of brother/sisterhood of patients.

This book manages to provide the same comfortable easy attitude even though it threw its net wide; patients from the USA and Canada as well as the UK provided information about their experiences and, above all, about how they felt about what happened to them.

Thus, there is discussion of pain—backache, pain in the legs from the site of removal of the veins used in the cardiac surgery (both apparently much worse than the pain from the chest operation site)—but with it clear appreciation of the fact that medical and nursing staff are not nowadays stingy with analgesics, and that some pain is not susceptible to them and must simply be lived with until it decides to fade away in its own time.

The simplicity of this extremely successful little book with its direct cheerful tone, together with all the useful information it provides about sources of further information, made me wonder why it is that the Government appears at present to be so anxious about ensuring patient involvement with all aspects of NHS practice, leading to the setting up of Patients' Forums and the like. What is needed is not formal bodies like Patients' Forums with their minutes and subcommittees and all the other paraphernalia so popular in today's highly structured Harvard Business School influenced NHS, but access to clear unvarnished patient opinion at source.

There is no suggestion anywhere in this book that Ms MacLachlan is an experienced writer or communicator or anything other than a warm observant human being with a lively interest in what happens to her and to people like her who share her experiences. Surely there are Ms MacLachlans all over the country in the NHS (or private wards; the author was not shy about including such patients in her review) who need simply to be identified (most experienced senior ward sisters would be able to do that) and given the opportunity to produce just such a text as this, but dealing with orthopaedic surgery, gynaecological surgery, or whatever.

It would certainly cost far less than the current efforts to “empower patients”—and I strongly suspect it would be a great deal more effective.