|
Office Practice of Medicine
|
|---|
3rd edition. WT Branch, Jr.; ed. 1174 pages. Philadelphia: WB Saunders; 1994. $95.00. ISBN 0-7216-4338-8. Order phone 800-545-2522.
In the preface to this edition of Office Practice of Medicine, the editor offers benchmarks against which to judge this book: "... a problem-oriented format that corresponds to the approach employed by a clinician when encountering a patient"; "... emphasis on health promotion and disease prevention"; and, most importantly, "... discussions that are both practical and sufficiently in-depth to be of use to the experienced practitioner."
The last statement begs the obvious question, What is it that a text should offer to be of use to the "experienced practitioner"? One would expect insights into the history and physical examination that allow a high degree of differential diagnostic discrimination; balanced consideration of the costs and benefits of diagnostic and therapeutic choices; clear guidelines for the sequencing of interventions; and discussions of primary prevention and risk moderation.
Taken individually (although they are written in a disease-oriented rather than a problem-oriented format), many of the chapters satisfy these expectations. As a group, they cover a broad range of important topics, including both disease entities and common clinical problems that the generalist must be able to evaluate and manage. A particular strength is that the discussions are up-to-date; most chapter bibliographies reference recent primary source materials.
As well developed as many of the individual chapters are, the book itself is less satisfying. It is difficult to understand the sequence of chapters. For example, the chapter titled "The Medical Interview and Related Skills," which ought to have primary importance, is placed toward the end of the book, relegated to the section labeled "Social-Psychiatric Problems." Similarly, the blocks of chapters under "Clinical Primary Care Problems" and "Screening and Preventive Medicine" are placed after a disease and organ-system arrangement of topics, taking precedence only over "Social-Psychiatric Problems." Within blocks of chapters, "generalist" topics such as risk prevention, health maintenance, and diagnostic test choice and use are most often placed after traditional discussions of disease entities. An excellent discussion of patient compliance is hidden within the chapter on hypertension as if hypertension were the only condition in which compliance deserves consideration. The not-so-subtle message of these placements is that these topics are of less importance than "real," organ-system pathology. This is unfortunate.
Finally, the editor has not imposed sufficient standardization on the chapters; each seems to have been constructed at the organizational whim of its own author. The reader cannot open to any individual chapter and be guided by the format to a particular element of information. Thus, the book cannot easily be used to quickly check a fact in the course of an ongoing patient visit.
Office Practice of Medicine handles like the syllabus for a graduate course on ambulatory general medicine. With tighter editing, it could have been of more immediate use to "the experienced practitioner."
Article
