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David Gray, Peter Toghill
344 pp Price £21.99 ISBN 0-340-73207-5 (p/b)
London: Arnold (Hodder Headline), 2001 .
I remember how it felt as a medical student coming to the ward for the first time. Your head is full of anatomy, biochemistry and the like but the challenge from now on will be a real patient—with symptoms, social circumstances and signs. You are meant to obtain the history and elicit physical signs in a logical and efficient way; but what happens? You get lost. You do not know from which side to approach the patient, how to begin, how to finish. What you need is a friendly and reliable guide. Failing a senior colleague with ample time, Gray and Toghill's Introduction to Symptoms and Signs in Clinical Medicine will serve the purpose very well.
This is not the first book of its kind, so what is special about it? Of course, the content overlaps with that of similar books. What differs is the style—student-friendly, non-paternalistic and pellucid. The first three chapters, dealing with general principles of examination and history-taking, offer a series of practical tips on how to approach the patient. You read about basics—what to ask, how to do it and even how to clerk. ‘How’ is a very important question for students. The next part is concerned with examination of different systems of the human body; and here the book differs from its rivals in containing chapters on matters such as an approach to the elderly, problems in pregnancy and how to examine unconscious patients. One chapter is about elderly muddled patients—who, students soon discover, make up a sizeable proportion of medical admissions. The third and last part looks into particular problems and syndromes encountered on the medical ward, not only detailing how to deal with them but also providing examples of the thought-sequences that lead to a clinical decision. Chest pain, headache, jaundice and dizziness are among the many matters discussed.
A good aspect of this book is that all the chapters are short and the subheadings are frequent. Besides, there are numerous boxes named revision panels and practical-points boxes that highlight the most important not-to-forget principles; and lots of diagrams and pictures accompany the text. Although Gray and Toghill's book may not be as comprehensive as some of the academic classics on clinical examination, it is more practical and memorable. Clearly the authors know how students feel and what they look for.