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Doody's Review ServiceReviewer: Vincent F Carr, DO, MSA, FACC, FACP (Uniformed Services University of the Health Sciences)
Description: This seminal book, originally published in 1988, has been republished, but not revised, by a new publisher, the American College of Physicians. The author acknowledges that there have been some changes in medical decision making since the initial publication, but that does not detract from this reissue. In fact, reading through this book emphasizes the accuracy and validity of the initial work, despite the time that has passed.
Purpose: The stated goals were for physicians and students to use the principles of probabilistic reasoning and expected-value medical decision making in day-to-day practice. Today, more than ever, this is a necessary step in providing cost-effective and safe medical care.
Audience: The audience includes every practitioner at every level, from the resident in training to the experienced attending and all levels in between, including physician-extenders. The author is one of the most respected practitioners and editors in medical literature in America.
Features: The author describes the process of developing a differential diagnosis, moves through probability theory, lands directly in the heart of the decision-making process, and resurfaces in a discussion of cost-effectiveness in managing medical care. The journey is made exquisitely and entertainingly effective and educational with its accessible text and "typical" patient-physician conversations. The figures, examples, and tables are superb, illustrating the statistical points of discussion. The index is most appropriate, and because the book is dated, the references are appropriate for the original publication date. The author states his intention to update the book upon retirement and hopefully this will occur. At the end of each section there are summaries, problems, and definitions of new words encountered in the chapter.
Assessment: Despite being a republication, this remains a highly valuable and educational book, with the vast majority of the information relevant to medical decision making in the current era. It deserves a place in every practitioner's library.