Second edition. Brendan M. Reilly; ed. 1320 pages. Philadelphia: W.B. Saunders; 1991. $120.00.

Internal medicine training is shifting its emphasis toward more outpatient rotations at both the medical school and residency levels. With this shift comes a need for a textbook that will provide both the student and preceptor with a core knowledge base for ambulatory training. The second edition of Practical Strategies in Outpatient Medicine only partially meets this need.

As a preceptor for a full-time outpatient ambulatory care course for senior medical students, I have felt the need for a text to correspond to the clinical material encountered. The first edition of the book (published in 1984) was in my office, but became less and less useful not only because of the copyright date but also because of its rambling presentation. Each of the 12 common problems was presented in depth, using a case-history format. While interesting to read the first time, a case history is inefficient as a reference source.

With the publication of the second edition, I was excited to see the change from a single author to multiple authors and the expansion to 22 topics and 1320 pages. New topics include liver dysfunction and hypertension, as well as less traditional but nonetheless common problems of primary care internal medicine such as dementia, depression, common eye complaints, and foot and ankle pain. Surprisingly absent is a chapter on preventive care.

These additions and changes notwithstanding, the essential weakness of the book remains the lack of an efficient, consistent format that would allow reference use in the office. The format varies significantly from chapter to chapter and the use of standardized section headings is uneven. The case histories, discursive discussions, and the limitation to 22 common problems make this book interesting reading when one has the leisure to read a whole chapter, but not so useful when the patient is in the office and a question needs to be answered promptly.

Another available textbook, Principles of Ambulatory Medicine, edited by Barber, Burton, and Zieve, better fills the need for a practical reference. Comprehensive and well organized, it discusses diagnoses as well as presenting problems. Practical Strategies in Outpatient Medicine is a useful addition to a home library for evenings when one has time to read a whole chapter.