Ethical Dilemmas in Healthcare

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    Relaxation for Concentration, Stress Management and Pain Control Using the Fleming Method edited by Carol Horrigan. Butterworfh Heinemann, Oxford, 1997 (ISBN 0 7506 2439 6). Illus. 155 pages. f14.99.

    Ursula Fleming was a pianist who in the late 1940s studied ways of focusing and relaxing her mind in order to improve her performance. Her mentor was Gertrude Hellor, a German relaxation therapist whose methods Ursula decided to study and develop as a full-time career.

    The Fleming method of pain control is a means of teaching patients to increase their level of pain tolerance by: 1. Increasing the ability of individuals to focus their attention. 2. To control (not inhibit) emotion.

    I t also aims to release habitual muscular tension and spasm, t o co-ordinate movement with breath- ing, and to correct faulty posture.

    Superficially it seems to have much in common with the Alex- ander technique by its emphasis on mental focusing, postural aware- ness and breathing patterns. I t also discounts imaging, tensing and relaxing techniques, and the passivity of the patient to receive relaxation treatment.

    Instead, patients are taught a number of simple lessons which help them focus on their own feel- ings and body sensations. These must be practised by patients so that they can call upon the skills learnt a t times of great anxiety and pain. Learning to accept and relax into adverse situations, rather than to exhaust themselves by resistance and prolonged tension and fear, enables patients to cope.

    This slim book describes the hist- orical background, 13 lessons for practical teaching both to health professionals and patients, specific needs information, case histories, epilogue (Ursula Fleming died in 19921, and a good reference and reading list.

    While reading the book, I thought how useful i t would have been if instead of teaching all those monotonous pre-operative breath- ing exercises on the surgical wards, I had been able to empower the patients with relaxation techniques such as these.

    I have some concern for the vocabulary used, since so often patients are deaf, have English as a second language, are not well educated, or unable to concentrate. Ursula Fleming emphasised the importance of not sticking to a script but many readers may end up using such phrases as have no preconceptions, breathing in is the influx of energy, this is an un- classified experience, dont predict sensations, and dont generate self-protective tension.

    The pioneer of this method was caring and compassionate. She offers something for those chroni- cally in pain, and the terminally ill. These are patients who often do not get enough attention in the mainstream of a general hospital. I t is a resource for holistic care to add to the traditional bread-and- butter manuals of physiotherapy department libraries.

    Maureen Dennis BA MCSP

    Ethical Dilemmas in Healthcare A practical approach through medical humanities by Rowena Murray. Chapman and Hall, London, 1997 (ISBN 0 412 62430 3). 184 pages. 1 6.99.

    The focus of this book is the group discussion of medical ethical issues using literary texts as a basis. Dr Murray describes a t length how she set up a reading group in Glasgow for health professionals, including physiotherapists. They meet on a regular basis and read three prepared literary texts -these may be fiction, poetry, biography or press articles. All the texts have a medical theme.

    In order not to intimidate the group, first discussions are limited to familiar uncontroversial subjects. The first one, for example, centres on being a patient in hospital. As the group gains in confidence it eventually progresses to subjects such as genetic engineering, death and bereavement.

    Rowena Murray describes in great detail how the meetings are constructed, and gives examples of the different texts she chooses and how they are related in order to stimulate discussion. She also lists the points that are raised by the

    group on the different texts, and the different reactions to certain issues. The group is encouraged to voice opinions around the subject and at each meeting after the reading members write freely. This free writing is always private and most of the group, once having got used to it, find it the most rewarding part of the session.

    At the first meeting the three extracts were from a poem After an Operation by Elizabeth Jennings; After a Stroke, a journal by May Sarton; and Robbie Kydds novel Auld Zimmery. As you can see they are carefully chosen and related subjects.

    The routine is for the first ten minutes of the session to be spent reading and voicing individual observations, then ten minutes writing free thoughts about the texts. To help those new to the group the facilitator will give direction with points for possible consideration. The group is then divided into pairs for discussion before a general debate. The facilitator does not lead the dis- cussion but allows i t to range around the subject. Finally the main points are summed up.

    I think the book is relevant to all physiotherapists and health-care workers as I believe it will help us to see our patients point of view and make us more reflective practi- tioners, considering the unspoken needs of our patients. I t should be available to all categories of physiotherapists.

    The book is well organised and presented; each chapter stating what is to be discussed and finishing with a summary of the main points. It has a comprehensive list of both literary and non-literary texts used.

    I t is a slim paperback and at sE16.99 good value for money.

    I would love to join a group like the one in Glasgow. Rowena Murray gives so much information and advice that it would be possible to run a group using her book as the starting point. If this is not viable, then the book itself does help us to look at texts differently and maybe learn from them.

    Yes, I enjoyed the book and found i t difficult to put down once I had started.

    Erica M Nix MCSP

    Physiotherapy, June 1997, vol83, no 6