Abstract
How would you rate this book? (5 star means excellent book useful for all GPs in training – a must have item; 1 star means poor book that you would not buy yourself)
What is good about this book?
Current demand on health services ensures that timely, focused clinical assessment remains a key skill for GPs. This book succinctly combines the key clinical points for performing such an assessment while retaining a holistic and patient-centred approach. Chapters are grouped logically by system; and organised by presenting symptom followed by key diagnoses, such as ‘shortness of breath’, followed later by ‘chronic obstructive pulmonary disease’. In the index at the back, it is possible to search for a topic across multiple chapters, such as ‘alcohol’ in the context of ‘abdominal pain’ or ‘tremor’. This allows the reader to search for information in multiple ways. Each topic is covered comprehensively and chapters stand alone so the book can be dipped into as required. The book would be helpful for the GP registrar in practice, but also for junior doctors working in acute settings, such as Emergency Medicine.
For those preparing for the Clinical Skills Assessment (CSA) examination, the ‘ideas, concerns and expectations’ section included in each chapter provides useful prompts for practising clinical scenarios. Likewise, ‘red flag’ symptoms are clearly highlighted in shaded boxes, allowing for quick navigation during surgery as well as aiding exam preparation. Useful web addresses are embedded in the text and a handy list of references is included at the end of each chapter to enable further reading.
It is refreshing to see a group of chapters under the heading of ‘undifferentiated and miscellaneous presentations’, including those on ‘frequent attenders’ and ‘medically unexplained symptoms’. In these chapters, the author includes useful tips for handling these often-challenging consultations. In this regard, the book very much speaks to GP trainees who are perhaps more likely to encounter these consultations with greater frequency than a hospital-based junior doctor. The book is somewhat unusual in that it is both an excellent rapid access reference text, but also a great resource for prompting lengthier reflection around managing different patient presentations.
What is bad about this book?
While providing a comprehensive guide to the important points to be covered in the history, examination and review of previous investigations, achieving all of this in a real-life, 10-minute consultation appears slightly ambitious. The book aspires to the ideal consultation. This is helpful for exam preparation and it does serve, as the author intends, as an aide memoire. However, it could perhaps have greater focus on what is realistic in practice.
In the preface, Dr Schroeder explains that the book deliberately does not include investigation and management because this would depend on the outcome of the clinical assessment, which is reasonable. However, the inclusion of such guidance for each topic would add a lot to the book’s practical application, and for the price of £49.99, this seems a significant drawback. For many junior doctors leaving hospital medicine and entering GP training, it is often the practicalities of implementing management in the community that is challenging, where access to investigations and certain treatments can be less immediate than in the hospital setting.
Finally, I would question some of the factual information included in the book, for example the idea that broad spectrum, non-liver, enzyme-inducing antibiotics alter the efficacy of the combined oral contraceptive pill.
On balance this book offers comprehensive coverage of a broad spectrum of topics in a well-structured, user friendly format. It would be a worthy addition to the busy GP registrar’s bookshelf.