Review

In the words of the American-based authors, ‘this book is written for hyper-busy clinicians/teachers and their trainees who face…challenges related to apparent gaps between the world of the class and the world of the wards’. The aim is to help bridge this gap and encourage readers to ‘constantly rethink assumptions, research information and reformulate basic mechanisms…fundamental to practicing medicine successfully’.

While acknowledging these honourable aims, it is quickly evident that this particular text may not be best suited to an Irish audience. However, the overarching theme of thorough history-taking and physical examination along with a healthy level of scepticism when reviewing information on any given patient stands to reason across all areas of medicine. A focus on encouraging an evidence-based medicine approach is also very relevant and helps to focus the student/junior clinician in order to avoid unnecessary and often expensive over-investigation.

The book is divided into two parts; the first part ‘Medical Musts and Must Nots’ focuses on the basics of taking and presenting a history and the second part ‘Medical Masteries’ attempts to challenge the reader and encourage critical thinking. The book has a focus on clear communication and constant review of supporting evidence throughout the diagnostic process.

The style of writing and approach to the basic history is very much written from an US perspective. The suggested presentation styles such as a ‘worsts first’ approach to differential diagnosis are also perhaps not best suited to the generally accepted style of presentation in Irish hospital medicine. The writing style is perhaps somewhat verbose with areas of repetition that make for a weighty read at times where a more concise approach may have engaged the reader more successfully and conveyed the fundamental message more succinctly.

However, the take-home message of this text is worth noting for all clinicians in that careful history taking and examination combined with critical thinking and constant re-evaluation of the available evidence serve us all well in minimising medical error and avoiding negative outcomes. Furthermore, discussions on medication adherence in chapter 1, ‘lab test ordering’ in chapter 3 and the limitations of randomised controlled trials in chapter 8 are particularly useful. This book is a valuable reference book for clinicians and students alike, and may act as a more detailed text for those involved in medical education.