Textbook of Physical Diagnosis: History and Examination
This textbook has many strengths. It is our current choice for students in our own course on physical diagnosis, and its earlier editions have been our choice for more than 10 years. The overall design of the book has much to recommend it. It is probably as brief as such a book can be without being reduced to an outline format. The CD-ROM in the fourth edition is beautifully produced and filmed and is a major addition to the textbook. In fact, we cannot find any comparable resource. This book gets students excited about physical diagnosis. It also helps faculty to design lectures about physical diagnosis, since it is very well pitched at the second-year medical student. Each chapter contains a series of typical questions that students can practice asking in their own history-taking routines. The diagrams and photographs are first-rate. Appropriate draping of both male and female patients is illustrated throughout the book and discussed in the text. Several chapters and sections -- "Putting the History Together," "Putting the Examination Together," and "Putting the Data to Work" -- synthesize subject matter in a way that helps the learner. The author does not confine himself strictly to physical examination and includes the interpretation of signs and symptoms, which we think is very helpful to students. We found the chapter on cultural issues to be nicely presented and useful. The focus on various cultures illustrates the practicality of incorporating cultural issues into the evaluation of the patient. Although we embrace this book and use it widely, some areas could be improved. For example, figures Figure 10-11 and 10-12 in the chapter about the ear show a 128-Hz tuning fork being used for the Rinne and Weber test; these figures should be replaced with photographs showing a 512-Hz tuning fork, which is described in the text as the proper one. Chapter 12, about the chest, is in general very good, and Table 12-7, about adventitious sounds, fills an important need for the student. The description of breath sounds, however, should be simplified to "normal," "decreased," and "bronchial." Chapter 15, about the breast, should advocate and include a diagram of the vertical-strip method of breast examination, which is superior to the old radial method of palpation. Chapter 19, "The Musculoskeletal System," is generally well written, but we prefer a rapid screening musculoskeletal examination such as that described by George V. Lawry and his colleagues. The ideal chapter might contain both the screening examination and a more sophisticated examination from the orthopedic point of view. Chapter 20, "The Nervous System," begins appropriately with a review of neuroanatomy and physiology; our quibble is with the mental-status examination. We applaud the avoidance of the Mini-Mental State Examination, since this is probably too much of a shortcut. Nevertheless, the example of the mental-status examination given in the book is from the neurologist's point of view, and it would be better if it were presented from the psychiatric perspective. The major omissions from the neurologic examination are the appearance, behavior, attitude, thought processes and content, and suicidal ideation of the patient. The section about coma could be enriched by an explanation of the Glasgow Coma Scale, which is widely used by neurosurgeons and emergency medicine physicians. Not only would this textbook be a wise purchase for the second-year medical student, it is also a useful reference for the practicing physician. The material in the book is well presented and easy to read and to reference. Despite the few exceptions noted above, it is the most accurate, up-to-date, and comprehensive textbook of physical diagnosis available today. Amid the mounting debate about the relevance of the physical examination, this book serves as a good reminder of its fundamental role in the practice of medicine, even in 2003.Holly J. Humphrey, M.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.