Historically, the mark of an internist was the ability to diagnose illness through the clinical history and physical examination. Many would say that the decline of internal medicine as a specialty has coincided with the rise of laboratory and imaging technology; correspondingly, skills once important to our profession have atrophied. Ironically, the increasing emphasis on limiting access to technology for financial reasons should allow physical diagnosis to play a more central role in the practice of internal medicine and throughout primary care.

Silverman and his colleagues at Piedmont Hospital in Atlanta present here a first attempt to re-emphasize physical diagnosis in medical practice. Originally developed as a didactic course for physicians at Piedmont Hospital, the material in this book has been formalized in print. The chapters, which correspond to individual lectures, were prepared by internists and subspecialists alike. Included are two chapters that discuss the clinical interview and associated psychiatric issues, as well as several chapters addressing the role of more common laboratory tests.

Any book of this kind must try to provide a balance between parsimony and excess. The discussant should provide the reader with a full range of techniques and with guidelines for their use in a screening examination; the authors achieve this with varying degrees of success. The descriptions of cardiovascular and abdominal examinations are limited to presentations of excellent technical information. The chapter on the neurologic examination distinguishes itself in its description of screening techniques. Other chapters, such as that on the skin, fall back on the format of the traditional physical diagnosis text. The discussion of laboratory testing is superfluous and generally does not reflect the evolution of clinical thought by such clinical guideline groups as the American College of Physicians.

Although primary care givers may benefit from a reassessment of clinical skills, I cannot recommend this book to a specific audience. Medical students will benefit most from the current crop of texts on physical diagnosis. Residents in training in most programs will review the topics included in this book during their own teaching sessions, hopefully in conjunction with instruction on how to approach particular common clinical symptoms. The practicing physician would garner some information from this text but might benefit from a more sophisticated treatment of these topics.

Richard P. Day, MD

Physicians Plus Medical Group

Madison, WI 53703