Although we general internists have begun to do many things formerly associated with general practice, our cachet continues to be our commitment to and pleasure in understanding the mechanisms of disease as we care for our patients. Know theory, and practice will follow. How, then, shall I respond to Murtagh's General Practice, a distillate of the pragmatic aspects of office patient care?

The book begins by aptly characterizing the physician as a trusted friend of the patient, and it closes with a wrap-up of the treatment of everyday office problems, from ingrown toenails and hangover to halitosis and teeth grinding. The conventional diseases are clustered together under leading common symptoms; thus, lung disorders and heart failure appear under the heading dyspnea. The author then proceeds to diagnosis and treatment by listing and discussing the possible causes of dyspnea, roughly according to their frequency of occurrence (obesity is near the top) and providing checklists of relevant serious disorders not to be missed (neuromuscular diseases, for example), pitfalls in diagnosis (such as pulmonary emboli), and masquerades (such as salicylate overdose). Murtagh always—wisely—closes by asking, Is the patient trying to tell me something?

Checking at random, I found that multiple myeloma receives 60 lines and rectal itching receives 160, and that the Shulman syndrome is missing from the section on arthritis. But I quibble, for almost everything that one needs to know to practice adult office medicine is here, along with sections on child and adolescent health, the special problems of men and women, and accident and emergency medicine. The information is readily accessible, the print is large, and the hundreds of line-drawn illustrations are clean and precise. Given that we know our theory, the book is a worthy complement to the Medical Knowledge Self-Assessment Program (MKSAP) and traditional medical texts—and it fits right in with the Washington Manual hidden in our physician bags.

John F. Burnum MD

Tuscaloosa, AL 35401