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Textbook of Adolescent Medicine
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Elizabeth R. McAnarney, Richard E. Kreipe, Donald P. Orr, and George D. Comerci; eds. 1280 pages. Philadelphia: W.B. Saunders Company; 1992. $120.00.
Good textbooks are more than compendia of technical facts to which a practitioner turns as a chef to a cookbook. Textbooks outline the perimeters of a field; when asked for a definition of a pediatrician or internist, we may lift a text and reply, "a master of this." The Textbook of Adolescent Medicine serves such a function for the subspecialty of adolescent medicine. Moreover, it points to the increasing sophistication all specialties need to treat adolescent patients.
The book's organization tells much about the breadth and depth of this emerging field. Four editors have used 9 consulting editors and 197 contributors to define the essential perspectives of adolescent medicine. The contributors support their discussions with data drawn from adolescents, rather than with extrapolations from younger or older age groups. For the internist who has struggled to deal with adolescents as somewhat capricious adults, such perspectives may be a revelation.
A section on the scientific basis of adolescent medicine summarizes epidemiologic, biologic, and developmental aspects of adolescence; chapters on the interface of biology and behavior in adolescence are especially appealing and useful. A section on clinical approaches to adolescents addresses a range of issues pertinent to clinical care of adolescents. A long section focuses on medical conditions. Several of these chapters are superb; the chapter on musculoskeletal neoplasia in adolescents, for example, fills important gaps in existing pediatric and internal medicine textbooks. The major section devoted to psychological issues is well-organized, with consistent attention to epidemiology, pathogenesis and identification of various disorders.
None of the flaws of this book are critical. For example, a few chapters are too superficial to be useful. Some material is duplicated but the chapters are cross-referenced to minimize substantial repetition. However, separate chapters on high blood pressure in adolescents and hypertension represent a mystifying and needless duplication. Most of the book's recommendations and approaches are reasonable, even when I believe them to be inadequately supported by data or too conservative in the interpretation of data. In addition, not all common conditions are adequately addressed: the book was of no help when I attempted to use it to teach medical residents about adolescent chest pain.
Many of the illnesses that are part of the daily practice of internists have obvious roots in adolescence; uncritical extrapolation from children or adults to adolescents is no longer appropriate for competent internists. This text helps clinicians to understand the aspects of biology, epidemiology, psychology, and clinical medicine relevant to the health care of adolescents. I highly recommend it for primary care internists (and pediatricians and family practitioners), as well as adolescent medicine specialists.
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