Medical Book Review – Clinical Examination. A systematic guide to physical diagnosis. Seventh Edition.Nicholas J Talley and Simon O’Connor
Churchill Livingstone/Elsevier
ISBN: 9780729541473 Publication
Date: 2014 RRP: $125.96 (free delivery in Australia/NZ).
For further information see: http://www.elsevierhealth.com.au/clinical-general-medicine/clinical-examination-paperback/9780729541473/
(Bonus
online resources (videos, ECGs and images) are available to purchasers of this
book through the Student Consult portal.)
The book is
also available in two other formats: a standard eBook containing the content
from the print edition plus four additional chapters covering the history and
examination of gynaecology, obstetrics, neonatology and paediatrics, and an
interactive enhanced eBook which contains the four additional chapters together
with OSCE videos, ECG case studies, an imaging library and MCQs.
I purchased the fourth edition of
this book (together with the pocket guide) when I was a medical student. This
paperback edition comes in at around 600 pages, and is physically larger than
its predecessor, and, unlike my earlier edition, contains an impressive number
of colour photographs and other illustrations and tables. I was literally ‘blown
away’ by the quality of the book (and its contents) as an educational resource,
and it is a book in which even a highly experienced practitioner can find learn
something from.
The Contents section follows straight
on from the Foreword, and is well set out with bolded headings which make it
easy to identify the topic of interest at a glance.
The book is divided into several key
sections:
1. The
general principles of history taking and physical examination;
2. The
cardiovascular system;
3. The
respiratory system;
4. The
gastrointestinal system;
5. The
genitourinary system;
6. The
haematological system;
7. The
rheumatological system;
8. The
endocrine system;
9. The
nervous system; and
10. Specialty
examinations.
The ‘specialty examinations’ have
been considerably expanded from my earlier edition, with seven topics covered
as opposed to the earlier three. These now include:
Chapter 38: The eyes, ears, nose and
throat;
Chapter 39: The breasts;
Chapter 40: The skin, nails and
lumps;
Chapter 41: A system for infectious
disease examination;
Chapter 42: Assessment of the
geriatric patient;
Chapter 43: Assessment of the
acutely ill patient; and
Chapter 44: Assessment of death.
There are three appendices which
were also present in my earlier edition (‘Writing and presenting the history
and physical examination’,’ A suggested method for a rapid screening physical
examination’ and ‘The pre-anaesthetic medical evaluation (PAME)’. The book
concludes with an extensive Index.
Most chapters conclude with two useful
and practical components, ‘T&O’C essentials’ and ‘OSCE revision topics’, and
a list of references.
The Preface (written by the two
authors) summarises their approach to this new edition:
“… we cover the core clinical skills
from the basics to an advanced level. We have taken an approach that is
patient-centric and evidence-based; the patient must always come first. The
edition has been brought right up to date with the latest clinical data,
including new research specially commissioned for this edition. Learning should
also be fun and the book is deliberately laced with humour and historical
anecdotes that generations of students have told us enhance the learning
experience.”
Further information concerning the
evidence-based approach which has been taken in this edition appears in the
Acknowledgments section, together with a list of the highly credentialed reviewers
who have also contributed to the manuscript.
I particularly enjoyed the next two
sections: ‘Clinical methods: an historical perspective’ and ‘The Hippocratic
Oath’. In keeping with the evidence-based approach, these are followed by a
section detailing ‘Credits: figures, boxes and tables’.
Section 1 (general principles of
history taking and physical examination) provides a structured approach to both
these elements together with abundant resources in terms of photographs, tables
and practical advice (including about OSCEs). There is a specific section on
evidence-based clinical examination.
In my work as a medical educator,
the clinical history and examination topic that we have most recently covered
with our students was the gastrointestinal system, so I have elected to look at
this chapter in some more detail as an example of the system-based chapters.
As is customary, this chapter begins
with a pertinent quotation, this time from Shakespeare. A short section on ‘examination
anatomy’ follows, containing a detailed colour illustration and descriptions of
the major areas in the abdomen of anatomical interest. The correct positioning for
examination is then described, and a systematic approach to examination
follows. This begins with jaundice and weight and wasting, and a very thorough
section on skin follows, together with several photographs and a very detailed
table setting out relevant diseases with skin and gut associations. The general
introductory section concludes with ‘mental state’. The next section covers the
examination of the upper limbs, beginning with the hands (nails and palms) and
a discussion of the most common relevant findings, proceeding to an explanation
of hepatic flap and then possible findings on the arms. Several illustrative
photographs and a table for assessing malnutrition are included in this section. The next topic looks at the face and head,
and includes discussions around the eyes, salivary glands and mouth. Several
photographs and tables are included. After a brief section on ‘Neck and chest’,
the chapter moves on to examination of the abdomen. This section begins with detailed
information on inspection and then a systematic approach to palpation of the
abdomen, including assessment of the major abdominal organs and possible causes
of other abdominal masses. Once again several helpful illustrations and tables
are included. Sections follow on percussion, ascites and auscultation. These
are also well supported by additional resources. A section follows on hernias
(including how to examine for these) with useful illustrations. Next is a detailed
section on rectal examination, including proctosigmoidoscopy. There is a brief
section on other areas of the body which may be relevant to examine, and then
the chapter concludes with a section on ‘Examination of the gastrointestinal
contents’ (including faeces, vomitus and urine. There is a helpful illustration
of the bilirubin pathway and a table listing the changes in urine and faeces
with jaundice. The final three elements
are the ‘T&O’C essentials (nine key points from the chapter), ‘OSCE
revision topics’ (five points) and the references.
There is also a complementary
chapter immediately following on ‘Correlation of physical signs and
gastrointestinal disease’. This covers examination of the acute abdomen, signs
commonly associated with chronic liver disease and portal hypertension, hepatic
encephalopathy and dysphagia, an approach to assessment and diagnosis of
gastrointestinal bleeding, a discussion of inflammatory bowel disease and finally,
malabsorption and nutritional status (signs, causes and classification).
Both these chapters are very
thorough but well-organised and laid out and are as a result easy to follow.
The plentiful illustrations and tables support the written text and enable the
reader to gain a better understanding of the subject matter. These additional
resources essentially make the book a ‘one stop shop’ so that in general it is
not necessary to look elsewhere for supporting materials to aid comprehension.
This is a magnificent book, which is
one of those references which will well and truly ‘stand the test of time’ and
the authors are to be congratulated on their efforts. Whilst the amount of
detail is probably in excess of that required for junior medical students, for
those undertaking their clinical training, and indeed for junior clinicians in
training it would provide an invaluable resource. It is also a well-loved
resource for medical educators. This is a book which has ‘something for
everyone’ and it is not hard to imagine that even highly experienced medical practitioners
would find it useful to turn to from time to time.
Verdict: Highly recommended!
