The 'human effect' referred to in the title is, in effect, the placebo influence of the physician. The authors, both general practitioners, describe this effect particularly in the category of patient that makes up the bulk of general practice; those with chronic and incurable disease. Nevertheless, they state that a wide range of disease shows marked placebo response including, for example, peptic ulcer disease.

To maximise the 'human effect', the authors emphasise the crucial importance of listening carefully to the patient, the actual words the doctor uses (especially his metaphors), the value of humour, and the need for continuity of care. The placebo effect is influenced by the attitude of both the doctor and the patient. The doctor's enthusiasm over a new remedy enhances its effect. The patient's expectations also have a positive influence. The colour and shape of pills is important, and while suppositories and injections have a greater effect than pills, a surgical operation has the most powerful effect of all.

The authors urge doctors to move beyond the idea of the body as a machine. If doctors do, indeed, regard their patients in this way, then this book is timely. One cannot help feeling that what is advocated is really a return to the best practice of family doctors of an earlier generation. Perhaps the authors recognise this in saying, 'What is called for is less of a revolution and more of a revival'.

Reviewed by
David Short
is emeritus professor of clinical medicine in the University of Aberdeen, past chairman of the medical ethics committee of the University of Aberdeen and the Grampian Health Board, and Physician to the Queen in Scotland.