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Textbook of Physical Diagnosis: History and Examination
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2nd edition. M Schwartz. 644 pages. Philadelphia: WB Saunders; 1994. $49.95. ISBN 0-7216-553-00. Order phone 800-545-2522.
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Physical Diagnosis: Bedside Evaluation of Diagnosis and Function
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JL Willms, H Schneiderman, and PS Algranati. 804 pages. Baltimore: Williams & Wilkins; 1994. $48.00. ISBN 0-683-091-107. Order phone 800-638-0672.
Many fine physicians have learned the art of physical diagnosis without benefit of a textbook. Moreover, writing a text on the physical examination is somewhat akin to writing a guide to fly-fishing: Much may be lost in the translation of action to the written word. This being the case, is there a need for this manual that is inherently so difficult to write? The answer is a resounding yes! A quick scan of any physician's office will show reference books about infectious disease, neurology, and internal medicine itself. It seems only appropriate, in this era of skyrocketing health care expenses, to have a reference book about one of the least costly of all medical evaluations—the physical examination. Those who learn physical diagnosis solely through observation and the guidance of more senior clinicians may be at a disadvantage when no longer in the presence of those colleagues. In addition, detailed inspection of specific organ systems may be best done by specialists in the field, persons not often at the neophyte's disposal. A reference book of physical examination skills is a tool on which one may always rely, both for review and for more extended investigation.
A few physical examination books have been widely used. These include Barbara Bates's A Guide to Physical Examination and History Taking and DeGowin and DeGowin's Bedside Diagnostic Examination. Bates's text is a plentifully illustrated, detailed guide that has become a standard against which physical diagnosis texts are measured. DeGowin and DeGowin's book is a prosaic, descriptive guide that includes discussions of pathophysiology. Two new publications have joined the ranks this year, attempting to encompass the best of both standard works.
Schwartz's textbook is well organized and concise and includes insightful suggestions on interviewing the "difficult" patient. Highlighted segments list the tools needed for examining each organ system, questions to ask during specific clinical presentations, and sample write-ups. There are also numerous color photographs of both normal and abnormal physical findings—crucial for the student with little or no clinical experience. An outstanding feature of this text is the page or two in each chapter in which the effect of organ system dysfunction on the patient is presented; this is a valuable addition to a medical student's education.
Willms and colleagues have produced a less impressive text. The language is ponderous, and the organization of chapters into "the screening examination" and "the extended examination" is clumsy and tedious. Only a few photographs show abnormal findings, and many of the black-and-white photographs are superfluous. The investigation of each organ system is more extensive than in Schwartz; excellent descriptions of the skin examination and of complete maneuvers for the cardiac examination (including the rarely used amyl nitrite) are given. Included at the end of each chapter are a few pages of further evaluation (such as blood tests, radiologic studies, and consultant suggestions), which are useful for students preparing for rounds. Descriptions of many obscure, eponymous physical signs may be of benefit to the student trying to impress.
The text by Willms and colleagues is not ideal for the novice, but it is a suitable reference for clinicians wishing to review detailed examination of organ systems. Schwartz's text surpasses the classic Bates as the standard text for learning history taking and physical examination skills, and it is more practical than DeGowin and DeGowin. It is both an excellent adjunct to hands-on physical examination sessions and a basic review for the practicing physician.
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