I just finished this book, cover to cover. I rarely read books like this all the way through. I scan them and keep them around in case they help me out of a jam. But this book is different. It is formative in the sense that the original Gang of Four (GoF) book on patterns was formative: it asks us to think about our problems in fresh ways.
One important part of this book, however, stresses the use and overuse of these patterns. Olsen emphasizes that this isn't a competition to use all the patterns. Whoever has the most patterns doesn't necessarily win. Whoever uses code gracefully and simply does. It reminds me of the talk by Marcel Molina Jr. at RubyConf 07, speaking about what makes code beautiful. It's the proportion, integrity, and clarity that makes beautiful code. I.e., we keep the code as simple as we can, keep it focused on the problem at hand, and we do it clearly. This book warns against misuse or abuse of patterns as much as it teaches the patterns themselves.
Another thing that I found very useful about this book is it suggests simpler ways for my existing code. This tells me that, though I was happy with the function of what I could do once, the form can improve that it doesn't fall apart in the face of future iterations.
Finally, I enjoy how each chapter evolves. We start with a rigorous interpretation of the GoF patterns, then Olsen introduces simpler ways to implement the ideas that take into account Ruby's available economies. So, we write simpler code, understand the tradoffs of the various alternative implementation methods, and understand the patterns themselves more concretely.
Other than the occasional loose editing that come up from time to time, I really wouldn't change what was written. I would have enjoyed more chapters on other patterns, even some that are outside the scope of the GoF book. But that's just a reflection of my respect for Olsen's love of the material and skill in teaching it.
If you're picking up Ruby to write Rails code, maybe start with the Agile Development book. If you've finished your first personal Rails project, or you have other uses of Ruby in mind, I'd suggest this as the next book you pick up. After this book, I'd next suggest The Ruby Way by Hal Fulton. That's probably the fastest way to pick up Ruby in a professional context.