Reviewer: Brigit E. Ray, MD, MME (University of Iowa Hospitals and Clinics)
Description: This update of a 2012 book, Differential Diagnosis in Primary Care, comes with a title change to highlight not only the algorithmic approach to medical diagnosis but also the evaluation and treatment regimes. This book is easy to navigate, using an alphabetical format to make it easy to find the symptom or disease process. Each symptom is algorithmically broken down in a mnemonic fashion to cover all potential diseases in order to not miss an item on a differential. For more visual learners, this list is accompanied by tables and anatomic diagrams for quick reference. The last two sections are dedicated to disease processes that may be signs of other underlying diseases and treatment/evaluation of common conditions, and the appendixes include dedicated case answers, laboratory evaluation, common medication treatment dosages for adults and children, and patient instructions. An accompanying ebook version is an exact replica of the print book, but has the added benefits of bookmarking, quick searching, highlighting, creation of flashcards, and addition of notes.
Purpose: The purpose is to assist undergraduate medical learners or young graduate medical learner/practitioners in applying the latest knowledge to clinical diagnostic reasoning, developing an algorithmic approach to diagnostic reasoning, assisting in selecting the appropriate diagnostic evaluation for common chief complaints/symptoms, recognizing when to refer to a specialist, and improving the clinician-patient interaction to form a more therapeutic relationship and decrease medicolegal action. Overall, the book achieves these objectives and the update is needed to reflect the next steps following the initial diagnostic reasoning in order to further aid in diagnosis. The online format brings the book into the modern era and facilitates use across multiple platforms.
Audience: According to the author, the target audience is general practitioners/primary care clinicians. However, a more appropriate audience may be undergraduate medical learners and early graduate medical learners/early practitioners who are trying to enhance their diagnostic reasoning skills, as the book appears to be more basic/entry level in nature. The focus of the book remains broad, across several disease symptoms/diseases, and the section on physical diagnosis remains a "generalist" approach. The author is highly reputable. He is an internal medicine physician who has been in practice for over 50 years, and he has held positions as associate professor of medicine at Medical University of South Carolina and University of Florida School of Medicine. He has published numerous books on algorithmic diagnostic approaches/clinical reasoning and laboratory diagnosis for general practitioners.
Features: The book is organized into four primary sections. The introductory section is new to this edition and is dedicated to reiterating the role of "good bedside manner" in delivery of care as well as helpful tips to strengthen the clinician-patient therapeutic relationship. The first section covers how to conduct a basic history and generalized physical exam followed by more focused physical exam maneuvers and findings. The more focused physical exam maneuvers appear to be somewhat dated in the terms used and there are several names for the same physical exam maneuver (i.e. tourniquet test vs. Rumpel-Leede test), which create confusion and aren't as widely used in any event. The second section presents the algorithmic approach to a wide variety of symptoms. The introduction to this section encourages the division of symptoms into the broad groups of pain, mass, bloody discharge, non-bloody discharge, functional changes, and abnormal laboratory results. While this helps readers to start thinking algorithmically, the author then delves into several mnemonics that create confusion about when to use one mnemonic approach over the other. The remainder of the section continues to build on the introductory material in a more focused manner and encourages learners to apply algorithmic thinking to a large variety of signs/symptoms. The symptoms are presented alphabetically for easy navigation. The author drives home the differential with tables, anatomic diagrams, and case studies. The writing is clear and the diagrams are easy to read. The last two sections and appendixes focus on diseases that are symptoms of other diseases, as well as treatment and referral recommendations for common diseases and commonly prescribed medications for adults and children. These sections allow readers to continue on their learning by pushing them to the next step, from diagnosis to treatment/management. The organization of these sections is easy to follow and provide quick references for common conditions, but overall it is not comprehensive.
Assessment: Overall, this sixth edition is a worthwhile update. This book serves as primer/reference for learners looking for an introduction to broad differentials, clinical reasoning, evaluation, and treatment. It is intended for learners interested in general medicine. However, it does appear to be more internist-oriented in that it tends to view disease processes in a narrower and more specialist-driven approach rather than the that of a family physician with a more holistic or biopsychosocial approach to treatment of the family throughout the lifespan as well as male and female cares. It is evident that the author has a vast amount of experience and that he attempts to impart not only the science behind medicine but the art of medicine. However, there are parts of the book that appear to be more outdated in regards to the use of terminology and some of the patient instructions (i.e. for upper respiratory tract infection suggesting bed rest for 24-48 hours). The updates on how to improve bedside manner to strengthen the clinician-patient relationship, patient cases, basic evaluation tests, and quick treatment references, along with the ebook, are make this a much richer book for beginning learners/clinicians. This is a good and quick reference for those interested in beginning their clinical diagnostic journey.
