A health education library for patients.

WITHIN THE TRADITIONAL framework of the physician-patient relationship, the primary concern of the physician is usually the diagnosis and treatment of a patient with a presenting problem. Underlying basic assumptions that are generally accepted are (a) responsible understanding by the patient of the medical advice given and (b) sufficient motivation for compliance with the physician's instructions because of the patient's desire to recover and stay well. Consequently, the area of specific educational mode and content; assessment of the patient's level of comprehension, ability or capability to concur or comply, or both; and recognition of the barriers to that end have received little attention. Thus, any determination of the patient's insights and educational needs before the possibility of any desirable behavioral change may have been overlooked or relegated to an office nurse, a family member, or a community resource. Recently, with more awareness of this distinction between medical advice and instructions and the patient's level of understanding and concomitant desire to comply, there has been an increasing use of audiovisual instructional aids in physician's examining offices and outpatient waiting rooms (1,2). Additionally, the trend today is toward more emphasis on the preventive and health maintenance aspects of medical care. The Oakland, Calif., facility of the Kaiser-Permanente Medical Care Program is a large prepaid group practice in an urban, ambulatory setting. A pilot program was developed at this facility to actualize a concept of a more rationally organized medical care delivery system (3) through allocation of medical resources according to needs of patients as detected by a health testing service. Within this system (fig. 1), incoming patients are triaged to sick care for discovered illness, to preventive maintenance care for early or asymptomatic disease, and to health care for health protection and maintenance information. A health library for patients was conceived as a subcomponent of health care which would enhance learning about health and disease; it has been developed as an integral part of the comprehensive delivery system.