Field of medicine: General medicine, family medicine, and emergency medicine.

Format: Softcover book.

Audience: Residents in primary care and emergency medicine, primary care physicians, and senior medical students.

Purpose: To improve the skills of primary practitioners performing minor surgical procedures. Secondary goals are to increase job satisfaction and decrease referrals to subspecialists for procedures that can be done in primary care settings.

Content: This book contains basic, practical advice on the performance of several common office procedures, but it is not meant to be comprehensive. Procedures are explained not from the point of view of specialists but from the perspective and experience of general practitioners with particular areas of expertise. The procedures discussed range from proctoscopy and joint aspiration to ear wax removal and the radiosurgical excision of nails and nevi. Chapters on setting up procedure rooms, infection control, the medicolegal aspects of performing procedures, principles of local anesthesia, and sending specimens to the histology laboratory are also included. Most chapters provide reference lists.

Highlights: The illustrations are the most outstanding feature of this book. In the chapter on soft tissue and joint injection, color photographs and color anatomic illustrations are placed side by side, providing an excellent guide to identifying landmarks and injection sites. Similarly, color photographs in one of the two chapters on dermatologic procedures are extremely helpful. By comparison, the adequate black-and-white sketches in the remaining chapters seem to have limited value. The writing is clear, and the instructions are easy to follow and extraordinarily practical. Important points are marked with boldface, bullets, and inset boxes.

Limitations: At a time when flexible sigmoidoscopy and endometrial biopsy are considered to be within the purview of primary care physicians, these procedures are conspicuously absent from this book. However, more specialized procedures, such as intrauterine device (IUD) insertion, cryotherapy of malignant melanoma, and sclerotherapy of varicose veins, are included. These choices may reflect primary care norms in the United Kingdom, where all but one of the book's contributors practice.

Context: By including practical information on selecting instruments, handling biopsy specimens, and performing a wide range of office procedures, this book has carved out a niche for itself. However, it cannot stand alone. By comparison, the much longer Procedures in Women's Health (Williams & Wilkins, 1997) discusses many of the same procedures. The visual aids in Procedures in Women's Health are less outstanding, but the range of procedures covered and the thoroughness of instruction are more satisfying and comforting to a novice. Practical Strategies in Outpatient Medicine (WB Saunders, 1991) is useful in its discussion of some procedures but limited in scope (for example, it does not discuss flexible sigmoidoscopy, cerumen impaction, or dermatologic procedures). Most other reference texts in outpatient general medicine, such as Principles of Ambulatory Medicine (Williams & Wilkins, 1991), Outpatient Medicine (WB Saunders, 1992), and Primary Care Medicine (Lippincott-Raven, 1995), do not emphasize procedures but discuss them briefly, usually without diagrams. Thus, Procedures in General Practice is a welcome companion to the standard texts in outpatient medicine and the reference books in orthopedics, dermatology, and gynecology found in most residents' clinics.

Reviewer: Catherine V. Caldicott, MD, University of Michigan Medical School, Ann Arbor, Michigan.

Commentary: Although medical training programs in the United States are based increasingly in the outpatient setting, many medical students, residents, and practicing physicians still believe that their training in office procedures is inadequate. This book will serve them well.