Oxford Textbook of Medicine
Authors: C D Shee
Journal: Journal of the Royal Society of Medicine (2005)

I received this CD-ROM with delight. This is the definitive British textbook on internal medicine and, although it is one I frequently consult, I had previously been too mean to buy my own copy. My delight was short-lived when I was unable to install the CD on my office PC. My NHS-issue PC (Windows 98) has a paltry 63 MB RAM, whereas the CD-ROM advises a memory of at least 128 MB RAM ('256 MB recommended'). I subsequently installed the CD on my PC at home (500 MB RAM) where it works perfectly.

Navigation around the electronic version is rapid and simple. There is a facility for labelling 'bookmarks' and 'favourites', but I did not find I needed these. The format is almost identical to that of the textbook (with some updated information) and there are no added multimedia features. One can browse the contents of the book by use of the table of contents, the index or a search function. The ability to search for words is a major advantage. Perhaps I am a technophobe, but I still find the book easier to read than the electronic version. The latter has an intrusive 'browsing panel' permanently displayed on the left, and the size of the text window is further reduced by a toolbar at the top. One can't always see a picture and its caption in the same field. Incidentally, the support website listed in the accompanying booklet states that for this CD-ROM there is 'no product support'; however, the booklet does offer an e-mail address and telephone number for customer support.

The fourth edition (2004) on CD-ROM has the entire contents of the printed textbook, including figures and tables. The book is billed as unrivalled in its coverage of 'internal medicine and its sub-specialties'. For this review I used it as a reference for problems encountered on general medical unselected acute 'takes'. Amongst diverse topics that I found well covered were brachial neuralgia, endocarditis, common variable immunodeficiency, Sudeck's atrophy, heart and lung transplant, hypernatraemia, and methaemoglobin (this last by Sir David Weatherall). Wearing my 'general medicine' hat I would have welcomed more emphasis on practical aspects of management. For instance, although there is superb coverage of the clinical presentation and pathology of multiple sclerosis, there is scant information on the practical management of respiratory and urinary infections in these patients. The harrassed physician will search in vain for guidance on the byzantine process involved in 'sectioning' patients under the Mental Health Act (although we are referred to the Concise OTM for further reading!). In my own specialty of respiratory medicine, coverage is excellent. A subject that probably warrants a longer and more comprehensive section in future editions is 'chronic cough'; most chest clinics will have a patient with this complaint.

The word-search facility in the electronic version is very useful since the index is not wholly reliable. For instance, I was unable to find either Duchenne's muscular dystrophy or hereditary spastic paraplegia in the index, although both topics are covered in the text. Looking under 'graft versus host disease' in the index one would be unaware that lungs can be involved (although bronchiolitis obliterans does occur separately in the index and is well-covered in the text). Similarly, the index was no use in finding the table of drugs that can cause hyponatraemia. The index could be made more doctor-friendly. 'Overdose', for instance, is a commonly used term that does not appear in the index; details of deliberate drug overdose are found in the text under 'Poisoning', and it would be a simple matter to say 'For overdose see Poisoning'. The index lists 'SSRIs' but with no link to the text.

This textbook, with its clear writing and its global emphasis, remains pre-eminent, but could it be improved? By a darwinian process, chapter headings in assorted textbooks are often similar, and the chapter headings here are, with a few exceptions, conventional. However, people present with symptoms, not neat diagnostic labels, and in future editions I would welcome a greater emphasis on investigation and management of specific symptoms. The chapter by Christopher Bass and Michael Sharpe on 'medically unexplained symptoms in patients attending medical clinics' is a model of how this can be achieved. In many sections, coverage of the practical aspects of disease management could be expanded. The index requires ruthless recompilation. Parenthetically, perhaps the time has come for the printed version to have the index in a separate volume rather than the triplication of appending the entire index to each constituent volume.

For this 'must-have' textbook would I recommend old-fashioned print (£295 for three volumes) or the e-version (£195)? If the index was more reliable I would still opt for the paper version, which is easier to read. However, the electronic version has the advantage of compact size, lower price, and an excellent word search facility. To use the CD-ROM at work, your NHS PC will have to have a more powerful memory than does mine.