Book review
GENETICS FOR HEALTH PROFESSIONALS, A LIFESTAGE APPROACH. By H. Skirton and C. Patch.
This useful book was written in 2002 by two British genetic nurses who intended it to be of value for any health professional interested in genetics. The subtitle, “A Lifestage Approach,” provides a rationale for chapters dealing with preconception, pregnancy, infancy, childhood and adolescence, and adult counseling. The focus of the book, once basic concepts of “genetic science” are covered, is on counseling concepts and applications to these lifestages, often reusing the same examples. This highlights very effectively that the emphasis of counseling issues—reproductive risk, natural history, implications for family members, and others—varies not only with the beliefs and values of the individual, but also with his/her stage in the lifecycle.
The first three chapters of the book review counseling theories that are illustrated by specific case examples. These include setting the scene for genetic counseling, and explanations of the basic tools, including risk assessment based on pedigree, population prevalence, and empiric observation. “Basic Counseling Skills” is reviewed in one-third of a page with a series of clear and sensible bullets, then developed by presenting theories of counseling. No matter how advanced the topic, such as Transactional Analysis, the explanations are simple and developed within the context of a specific case. The need for ongoing supervision of counselors in practice is highlighted by a dramatic example of a midwife counselor whose personal life experience interfered with her ability to provide grief counseling to a couple with a fetal demise.
The fourth chapter presents the basics of genetic science with brevity and clarity. Unfortunately, the methods presented for molecular genetic testing—PCR as a stand alone, RFLP analysis—harken to an earlier era and do not include DNA sequencing, direct detection of mutations, and short tandem repeat analysis. This is a serious shortcoming to the book, as counselors are called on to explain the means and interpretation of genetic tests. This chapter is followed, in turn, by a series of “lifestage” chapters. The exceptionalism of each of these stages is carefully discussed, illustrated with case examples, reinforced with “key practice points” boxes, and then tested with case discussion questions. The references for each chapter are appropriate and useful and an appendix that provides links to a variety of websites adds strength to the book. Some of their efforts fell flat. Unlike the counseling and risk discussions where the authors made the complex easy to understand, the review of dysmorphic features introduces many technical terms without explanation or illustration, thus limiting utility for most healthcare professionals.
The final chapter discusses the development of genetic services and the genetic counseling profession. For a non-British reader, it would be unclear how genetic counselors work within and outside the National Health Service. Similarly, a lack of detail would make it difficult for readers to understand how genetic counselors are trained and practice in the United States and other countries. Inadequate attention was paid to the variety of American authors and professional organizations who developed the profession of genetic counseling. For nursing students or other health professionals without much prior knowledge of basic genetics, this volume will be instructive and challenging.
