LETTERS
This additional information reinforces our belief that hospitals consider allowing patients to use inthat the slide-tape as a teaching tool for library formation resources on "a prescription basis instruction is successful. only." Either every patient (or their guardian) has VIRGINIA B. HALL the right to know and to exercise choices or none DANIEL KRAUTHEIM do. This does, of course, place tremendous BALJI S. HANSRA responsibility on the librarian to provide a Columbus, Ohio trustworthy collection, but where the librarian is part of the health care team this is both possible and rewarding. The description of the hospital patient educaHEALTH INFORMATION FOR PATIENTS tion committee evidences some painfully didactic To the Editor: thinking. The key to a functioning committee is a While I am delighted to find a colleague in print, blend of two traits-interest and power. To asand on my favorite subject, I feel that I must cribe either to only two professions (physicians respond to Britain Roth's article "Health in- and nurses) is appalling and unrealistic. By the formation for patients: the hospital library's role" same token, to designate the librarian as chair(BMLA 66: 14-18, Jan. 1978) with some observa- person assumes that all in the profession tions after several years of experience in a patient inherently have the interest, power, and skill library. which are necessary to chair an effective commitIt is true that the AHA has done much to clar- tee. ify patient health education issues but, sadly, this The suggestion that the patient education comhas happened without involving librarians in the mittee review all materials for purchase presents planning and decision-making process, despite in- two major problems. First, it is a monumental dications of concern on the part of individuals and task to review all the materials even in one field professional groups. The AHA's current interest -there are few staff people (however interested) in a national clearinghouse for patient education who can tolerate the tedium and extra time rematerials makes mutual consultation imperative. quired on a sustained basis. Second, the key to Mr. Roth does not mention several resources having referrals to patient education materials is which have begun to play important roles in the to have the prospective referral-maker a part of development of a national health education the selection process. Similar objections must be program. The Bureau of Health Education is at- raised in response to the suggestion that the tempting to provide coordination, at least in the patient education committee establish individual federal sector (they also funded the 1975 AHA program objectives. Incidentally, patients should survey on patient education). The National Center have a voice too. for Health Education was established in 1975 to Patient education programs need a supportive, provide state-of-the-art information and some coordinating force (and this can be a committee), coordination in the public sector. Both are but the kiss of death to a planned program of resources which must be explored and in which patient education is dogmatic rigidity with regard the library profession must become involved. to committee composition and function. Mr. Roth errs seriously in implying that patient Our experience, after two years of libraryeducation has been accepted as a reimbursable centered patient education indicates that using service. The third-party payers say, in essence, MeSH terms in the catalog provides inadequate "Of course patient education is an integral part of access for patients (and occasionally for staff). A health care. In fact, it is so integral that we will collection intended to provide patients with innot pay for it as a separate cost." The hospitals formation should be directly accessible by the respond, "It is costly, cannot be covered by cur- intended client. (Currently, a graduate student rent room rates, room rates cannot be raised, and assigned here is surveying patient use of terms to so we must charge separately to meet inherent describe medical conditions and surgeries for expenses." The outcome of this rhetorical impasse comparison to MeSH terms. Early indications are is that very few patients are ever reimbursed for that there is a significant gap between popular use patient education. There is a lot of supportive and MeSH). noise but little cash. The inclusion of TEL-MED in a list of library I found it impossible to square the author's en- materials is most puzzling. TEL-MED exists in a dorsement of the ALA "Library Bill of Rights" large number of cities as a public information (which I heartily support) with the later statement service. It cannot be purchased and requires a
362
Bull. Med. Libr. Assoc. 66(3)July 1978
LETTERS large and faithful volunteer force to implement its use.
The inclusion of the Core Communications in Health materials in the resource list should have been accompanied by a note that materials are not for sale and require staff time commitments (which we have found to be approximately forty minutes per patient.) We use the CCH materials and think highly of them, but the staff time involved is not trifling and the impact on other services provided is great. The experience here in hospital library-based patient education has taught one sure lesson. There are no formulas for success-the most important ingredient the librarian can bring to the program is flexible participation on the health care team.
LIONELLE ELSESSER Minneapolis, Minnesota
Ambulatory Care and the Department of Medicine (both physicians), Dietetics, Pharmacy, Social Work, Nursing Education, Clinical Nurse Specialist, Alcohol Program, as well as the library. Any other special program in the hospital with a teaching function should also be included. All of these services have direct contact with patients and do patient teaching in their areas of expertise. We feel that it is important for these contacts to be coordinated, otherwise the physician and dietician may each assume that the other has covered a certain aspect of a patient's diabetes, for instance. In today's hospital the number of specialities is increasing all the time and the physician and nurse can no longer be expected to be the be-all and endall of direct patient care. LYNNE D. MORRIS Chicago, Illinois
To the Editor: CITATION ANALYSIS Although I cannot wholly agree with Ms. Elsesser's various and firmly held positions, I am To the Editor: glad to hear how other hospital librarians are adI have some comments on the paper by P. W. dressing patient health education. Brennen and W. P. Davey, "Citation analysis in As each hospital and clinic differ, library the literature of tropical medicine," BMLA 66: services to patient education programs should be 1978. 24-30, Jan. evolving. It is my hope that a part of that evolution will be the beginnings of meaningful discussion on 1. There is no doubt that English is by far the the hospital librarian's role in providing resources most important language for researchers in the field of tropical medicine, but its impact is overto the health education community. BRITAIN G. ROTH emphasized. An English-language abstracting Miami, Florida journal like Tropical Diseases Bulletin will of course have a tendency to review more Englishlanguage journals and articles than foreign ones. This is made clear for instance in Table 2 where To the Editor: one can see that the number of articles cited per Mr. Roth's article, "Health information for number of titles is generally less for foreign compatients: the hospital library's role" (BMLA 66: pared to the English-language publications, while 14-18, Jan. 1978) is an excellent overview of a there is no evidence that the former publish less topic which is becoming more and more important articles per title than the latter. One must bear in to all of us who are librarians, or who might one mind that Tropical Diseases Bulletin is a critical, day be patients. I am pleased to see it in BMLA. selective abstracting journal and by no means a I would like to make one comment about the comprehensive indexing service. committee Mr. Roth discussed that would coor- 2. There is no doubt that the position of the first dinate the patient education program. It is my two journals in the rank-order list is correct, but firm belief that limiting membership on this com- they are followed by a mixture of tropical mittee to physicians and nurses would be a mis- medicine journals, general journals (Lancet, Natake. I do not think he meant to leave out allied ture), and very specialized journals (Mosquito health personnel but I think more emphasis is News, Leprosy Review). Few valid conclusions necessary. At our VA Hospital the committee is may be drawn from this list, especially because no truly multidisciplinary. The chairperson is the account has been given of whether the articles Associate Chief of Staff for Education (a phy- were merely cited or more or less extensively sician) and members include representatives from abstracted. For instance, the Annales de la Bull. Med. Libr. Assoc. 66(3) July 1978
363
This additional information reinforces our belief that hospitals consider allowing patients to use inthat the slide-tape as a teaching tool for library formation resources on "a prescription basis instruction is successful. only." Either every patient (or their guardian) has VIRGINIA B. HALL the right to know and to exercise choices or none DANIEL KRAUTHEIM do. This does, of course, place tremendous BALJI S. HANSRA responsibility on the librarian to provide a Columbus, Ohio trustworthy collection, but where the librarian is part of the health care team this is both possible and rewarding. The description of the hospital patient educaHEALTH INFORMATION FOR PATIENTS tion committee evidences some painfully didactic To the Editor: thinking. The key to a functioning committee is a While I am delighted to find a colleague in print, blend of two traits-interest and power. To asand on my favorite subject, I feel that I must cribe either to only two professions (physicians respond to Britain Roth's article "Health in- and nurses) is appalling and unrealistic. By the formation for patients: the hospital library's role" same token, to designate the librarian as chair(BMLA 66: 14-18, Jan. 1978) with some observa- person assumes that all in the profession tions after several years of experience in a patient inherently have the interest, power, and skill library. which are necessary to chair an effective commitIt is true that the AHA has done much to clar- tee. ify patient health education issues but, sadly, this The suggestion that the patient education comhas happened without involving librarians in the mittee review all materials for purchase presents planning and decision-making process, despite in- two major problems. First, it is a monumental dications of concern on the part of individuals and task to review all the materials even in one field professional groups. The AHA's current interest -there are few staff people (however interested) in a national clearinghouse for patient education who can tolerate the tedium and extra time rematerials makes mutual consultation imperative. quired on a sustained basis. Second, the key to Mr. Roth does not mention several resources having referrals to patient education materials is which have begun to play important roles in the to have the prospective referral-maker a part of development of a national health education the selection process. Similar objections must be program. The Bureau of Health Education is at- raised in response to the suggestion that the tempting to provide coordination, at least in the patient education committee establish individual federal sector (they also funded the 1975 AHA program objectives. Incidentally, patients should survey on patient education). The National Center have a voice too. for Health Education was established in 1975 to Patient education programs need a supportive, provide state-of-the-art information and some coordinating force (and this can be a committee), coordination in the public sector. Both are but the kiss of death to a planned program of resources which must be explored and in which patient education is dogmatic rigidity with regard the library profession must become involved. to committee composition and function. Mr. Roth errs seriously in implying that patient Our experience, after two years of libraryeducation has been accepted as a reimbursable centered patient education indicates that using service. The third-party payers say, in essence, MeSH terms in the catalog provides inadequate "Of course patient education is an integral part of access for patients (and occasionally for staff). A health care. In fact, it is so integral that we will collection intended to provide patients with innot pay for it as a separate cost." The hospitals formation should be directly accessible by the respond, "It is costly, cannot be covered by cur- intended client. (Currently, a graduate student rent room rates, room rates cannot be raised, and assigned here is surveying patient use of terms to so we must charge separately to meet inherent describe medical conditions and surgeries for expenses." The outcome of this rhetorical impasse comparison to MeSH terms. Early indications are is that very few patients are ever reimbursed for that there is a significant gap between popular use patient education. There is a lot of supportive and MeSH). noise but little cash. The inclusion of TEL-MED in a list of library I found it impossible to square the author's en- materials is most puzzling. TEL-MED exists in a dorsement of the ALA "Library Bill of Rights" large number of cities as a public information (which I heartily support) with the later statement service. It cannot be purchased and requires a
362
Bull. Med. Libr. Assoc. 66(3)July 1978
LETTERS large and faithful volunteer force to implement its use.
The inclusion of the Core Communications in Health materials in the resource list should have been accompanied by a note that materials are not for sale and require staff time commitments (which we have found to be approximately forty minutes per patient.) We use the CCH materials and think highly of them, but the staff time involved is not trifling and the impact on other services provided is great. The experience here in hospital library-based patient education has taught one sure lesson. There are no formulas for success-the most important ingredient the librarian can bring to the program is flexible participation on the health care team.
LIONELLE ELSESSER Minneapolis, Minnesota
Ambulatory Care and the Department of Medicine (both physicians), Dietetics, Pharmacy, Social Work, Nursing Education, Clinical Nurse Specialist, Alcohol Program, as well as the library. Any other special program in the hospital with a teaching function should also be included. All of these services have direct contact with patients and do patient teaching in their areas of expertise. We feel that it is important for these contacts to be coordinated, otherwise the physician and dietician may each assume that the other has covered a certain aspect of a patient's diabetes, for instance. In today's hospital the number of specialities is increasing all the time and the physician and nurse can no longer be expected to be the be-all and endall of direct patient care. LYNNE D. MORRIS Chicago, Illinois
To the Editor: CITATION ANALYSIS Although I cannot wholly agree with Ms. Elsesser's various and firmly held positions, I am To the Editor: glad to hear how other hospital librarians are adI have some comments on the paper by P. W. dressing patient health education. Brennen and W. P. Davey, "Citation analysis in As each hospital and clinic differ, library the literature of tropical medicine," BMLA 66: services to patient education programs should be 1978. 24-30, Jan. evolving. It is my hope that a part of that evolution will be the beginnings of meaningful discussion on 1. There is no doubt that English is by far the the hospital librarian's role in providing resources most important language for researchers in the field of tropical medicine, but its impact is overto the health education community. BRITAIN G. ROTH emphasized. An English-language abstracting Miami, Florida journal like Tropical Diseases Bulletin will of course have a tendency to review more Englishlanguage journals and articles than foreign ones. This is made clear for instance in Table 2 where To the Editor: one can see that the number of articles cited per Mr. Roth's article, "Health information for number of titles is generally less for foreign compatients: the hospital library's role" (BMLA 66: pared to the English-language publications, while 14-18, Jan. 1978) is an excellent overview of a there is no evidence that the former publish less topic which is becoming more and more important articles per title than the latter. One must bear in to all of us who are librarians, or who might one mind that Tropical Diseases Bulletin is a critical, day be patients. I am pleased to see it in BMLA. selective abstracting journal and by no means a I would like to make one comment about the comprehensive indexing service. committee Mr. Roth discussed that would coor- 2. There is no doubt that the position of the first dinate the patient education program. It is my two journals in the rank-order list is correct, but firm belief that limiting membership on this com- they are followed by a mixture of tropical mittee to physicians and nurses would be a mis- medicine journals, general journals (Lancet, Natake. I do not think he meant to leave out allied ture), and very specialized journals (Mosquito health personnel but I think more emphasis is News, Leprosy Review). Few valid conclusions necessary. At our VA Hospital the committee is may be drawn from this list, especially because no truly multidisciplinary. The chairperson is the account has been given of whether the articles Associate Chief of Staff for Education (a phy- were merely cited or more or less extensively sician) and members include representatives from abstracted. For instance, the Annales de la Bull. Med. Libr. Assoc. 66(3) July 1978
363
