M Dixon and K G Sweeney, Abingdon, Radcliffe, 2000, 157 pages, £17.95

Given that in England and Wales triage, access and treatment based on national frameworks are increasingly important for politicians and therefore for the National Health Service (NHS), clear advocacy for the human effect in medicine is timely. The NHS plan for England proposes an end to single-handed general practices, and the huge investment in NHS Direct with its dependence on binary chain logic to assess patients' needs may lead to this being the single gateway to primary health care. So, whilst in the foreword of this book Denis Pereira Gray says that “the pendulum has started to swing back to the personal” he clearly refers to academia rather than health policy.

Reviewing the theory of the subject in the first of three sections in the book, Kieran Sweeney assesses the philosophy and history of medical practice. In common with the rest of the book, the human effect being examined is almost exclusively patient-doctor rather than the broader range of care professions. He traces scientific rationalism and the relationship between objectivity and subjectivity in medicine from the Hippocratic tradition through Descartes to the evidence based medicine movement. Professor David Sackett's statement: “in all this, the assumption …