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CLINICAL COMMENTARY
A General Internist\'s Library
Hawkin Woo, M. D.
As a clinician-educator, you are probably asked by medical students and housestaff what textbooks you
recommend. Busy trainees and clinicians are both pressed for time and need effective resources for the
learning and practice of medicine. I found the following books very useful as a practicing general
internist and clinician-educator.
Primary Care Medicine (Gorroll and Mulley, Jr.):
What makes this book so helpful is the chapter organ-ization.
Just like in clinical practice where sometimes the chief complaint is known but maybe not the exact
diagnosis, the book outlines an approach to many common chief complaints. For example, the chapter \"Approach To the Woman with Abnormal Vaginal Bleeding\" summarizes the pathophysiology of
menses, then the work up by history, examination, and laboratory study for an unknown menstrual disorder.
Chapters end with recommendations on when to get a consultation or refer for inpatient management.
Principles of Ambulatory Medicine (Barker et al):
Mostly written by Johns Hopkins faculty, this book is
excellent and arranged in the more traditional format of chapters by diagnoses. The text is well-referenced
with literature and gives detailed therapeutic recom-mendations needed by the busy clinician. For
example, the chapter on urinary stones goes over dietary modifications, specific dosages of thiazide
diuretics and citrate supplements.
Current Medical Diagnosis and Treatment (Tierney et al):
Mostly written by UCSF faculty, this book may
be the best bargain for an internal medicine textbook. Published annually, the book covers the traditional
breadth of internal medicine, but somehow remains concise so it is not a huge tome. I found it to be an
authoritative resource during internal medicine board preparation. Priced at about $60, this is definitely a
high-yield, low risk investment.
Kammerer and Gross\' Medical Consultation: The Internist on Surgical, Obstetric and Psychiatric
Services (Gross et al):
Most trainees and primary care physicians are familiar with requesting specialty
consultations, but less familiar to the role of providing consults. This book covers medical consultation in
the frequent setting of preoperative and perioperative care. For example, there is an excellent review of the
evidence for preoperative testing and a good discus-sion on common postoperative problems like elevated
creatinine and fever. A longer chapter on \"Medical Illness during Pregnancy\" would have made this book
even better than it already is.
Managing Contraceptive Pill Patients (Dickey):
Already in its 11th edition, this pocket-sized
handbook is a quick yet thorough reference for all clinicians caring for women on oral contraceptives.
Individual chapters are devoted to the effects of oral contraceptives on each organ system. The sections on
starting pills and on menstrual changes associated with pills are extremely practical to clinical practice.
Diagnostic Strategies for Common Medical Problems (Black et al):
For physicians who teach medical
students and housestaff, this book is a great source of information for attending rounds and didactic
sessions. For example, the chapter on pulmonary embolism reviews the literature for sensitivity, speci-ficity
and likelihood ratio of symptoms such as dyspnea, signs such as a pleural friction rub, and lab
tests like an arterial blood gas. Chapters conclude with sample case scenarios, where a testing strategy is
outlined based on what was just reviewed.
Sapira\'s Art and Science of Bedside Diagnosis (Orient et al):
If you love the art of physical diagnosis, this
book deserves to be on your shelf. Each chapter goes over an organ system and is packed with interesting
anecdotes, historical vignettes and of course obscure physical signs. For example, most clinicians know
Kussmaul\'s sign, but how about d\'Espine\'s or Doi\'s? Old-school clinicians will enjoy this book as a link to
the days of the giants.
Teaching in Your Office: A Guide To Instructing Medical Students and Residents (Alguire et al):
This
book is an excellent primer for clinicians who work with medical students and housestaff in the outpatient
setting, although the techniques are applicable in most medical education settings. The core of this primer
goes over case-based learning techniques, in partic-ular, the \"microskills model.\" Another useful section
goes over the often-dreaded task of evaluating a trainee.
Essentials of Musculoskeletal Care (Greene):
This book published by the American Academy of
Orthopedic Surgeons is a concise reference with clear pictures demonstrating the musculoskeletal exam and
radiological findings. The human figures sketched with pain locations and probable diagnoses are
helpful as well. Each chapter ends with recommen-dations on when to obtain an orthopedic consultation.
Medicine (Chan et al):
Essentially a pocket handbook full of admission orders for various admitting diag-noses,
this book comes in very handy when on-call and it is late at night. The orders are extremely
thorough. For example, the pneumonia admission orders include PPD placement, which is not necessary
for every patient, but can be a helpful reminder on points to consider for the exhausted on-call physician.
Color Atlas and Synopsis of Clinical Dermatology (Fitzpatrick et al):
Filled with beautiful color plates,
this comprehensive yet concise book is very useful in primary care practice. The therapy recommendations
are detailed and usually include multiple options, truly important in a managed care environment with
formulary restrictions. Priced at about $60, this book is another \"more bang for the buck\" library addition.
UpToDate:
Available online or on PC by CD-ROM, this electronic textbook is basically an ever-growing
collection of well-written monographs. Each chapter has a date of authorship and is full of evidence-based
material. This is a great teaching resource for attending rounds and other didactic venues. However,
the annual subscription fee of $495 for first-timers and $395 for continuing subscribers can be somewhat
costly.
Many wonderful books were not mentioned, such as The Sandford Guide to Antimicrobial Therapy and Tarascon Pocket Pharmacopoeia, but hopefully you enjoyed reading about some of my favorite books.
BIBLIOGRAPHY
1. Goroll AH, Mulley AG. Primary Care Medicine: Office Evaluation
and Management of the Adult Patient. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
2. Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2003.
3. Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical
Diagnosis and Treatment. 43rth ed. New York, NY: Lange Medical Books/ McGraw-Hill; 2004.
4. Gross RJ, Caputo GM, eds. Kammerer and Gross\' Medical Consultation: the Internist on Surgical, Obstetric, and Psychiatric
Services. 3rd ed. Baltimore, MD: Williams & Wilkins; 1998.
5. Dickey RP. Managing Contraceptive Pill Patients. 11th ed. Durant,
OK: Essential Medical Information Systems; 2002.
6. Black ER, Bordley DR, Tape TG, Panzer RJ, eds. Diagnostic
Strategies for Common Medical Problems. 2nd ed. Philadelphia, PA: American College of Physicians; 1999.
7. Orient JM. Sapira\'s Art and Science of Bedside Diagnosis. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
8. Aguirre PC, Dewitt DE, Pinky LE, Ferenchik GS. Teaching in Your Office: A Guide to Instructing Medical Students and Residents.
Philadelphia, PA: American College of Physicians-American Society of Internal Medicine; 2000.
9. American Academy of Orthopaedic Surgeons, Greene WB. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, IL:
American Academy of Orthopaedic Surgeons; 2001.
10. Chan P, Safani M, Winkle PJ. Medicine. 2005 ed. Fountain Valley,
CA: Current Clinical Strategies Publishing; 2004.
11. Fitzpatrick TB, Johnson R, Wolff K, Suurmond R. Color Atlas
and Synopsis of Clinical Dermatology: Common and Serious Diseases. 4th ed. New York, NY: McGraww-Hill Medical
Publishing Division; 2001.
12. UpToDate? Available at: http:// www. uptodate. com
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