approach to medical care. In the first section social, ... book of internal medicine on the subject of the elderly .... require the use of a dictionary. Finally, the book ...
of the elderly. Each of the nine sections is based on a symptom approach to medical care. In the first section social, economic and ethical issues are briefly reviewed. The second section covers general care issues important to geriatric practitioners (such as the physician-patient relationship), preventive medicine, living conditions and the hospitalized elderly patient. The third section includes chapters on confusional and neuropsychiatric states; the cursory presentation on the cognitive, language and functional behaviour of people with Alzheimer's disease and other dementia syndromes is less than adequate. The fourth section describes, in limited detail, various sensory and skin problems. Section five addresses genitourinary problems including incontinence and catheterization considerations, diseases of the prostate, sexual disturbances and renal disease. Section six is by far the largest; the seven chapters discuss cardiovascular and pulmonary problems of the elderly but, like the chapters in preceding sections, fall short in providing practical clinical management strategies. The three remaining sections briefly examine musculoskeletal diseases, immunologic, hematologic, oncologic and infectious disease problems, and gastrointestinal, metabolic and endocrine disease. Because this text is comprehensive it suffers from a lack of detail. Many important areas receive too little attention. Consequently, readers are left to search in specialty texts for the necessary information. Moreover, the book was written not by geriatricians but by internists, who have not incorporated an interdisciplinary focus. Like many other texts on geriatric medicine this one contains few comments on management of the complex biopsychosocial problems of older adults. 546
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Although the book may serve the general needs of medical students, family practitioners and internists it fails to deliver the detailed information necessary for those looking for practical guidance in managing the medical needs of the elderly. This is a book of internal medicine on the subject of the elderly rather than a text of geriatric medicine. J.B. Orange, PhD Research fellow R. Samuel McLaughlin Centre for Gerontological Health Research McMaster University D. William Molloy, MB Director, Memory Clinic Henderson General Hospital Hamilton, Ont.
Problem-oriented approach Internal Medicine on Call. Edited by Steven A. Haist and John B. Robbins. Series editor, Leonard G. Gomella. 534 pp. Illust. Appleton & Lange, Norwalk, Conn. 1991. $21 (US). ISBN 0-83854052-X his pocket-sized manual is directed toward medical students and house staff in need of quick reference during their demanding schedule; it glides easily in and out of the laboratory coat pocket. I circulated the book for evaluation by those who would best know its utility - the house staff. Their reviews were mixed but in some cases overwhelmingly positive. Given the extreme breadth of topics that might have been presented the authors have done an excellent job of covering the common and life-threatening problems for which early intervention is needed. A quick examination of the contents reveals that this is a problem-oriented text; the problems are listed in an unresolved form and in alphabetical order for
ease of identification. The book is therefore set up in the way patients actually present - not, for example, with a pulmonary embolism but with chest pain or hemoptysis. The house staff who were disappointed with the book were likely looking for more of a discussion of the topic; for most readers, however, this patient-oriented approach means much more and is more memorable. The comments on history are followed by "Immediate Questions," including enquiries about features that may indicate common conditions or acute processes requiring urgent intervention. The section on differential diagnosis is much more extensive than that in similar manuals but is still practical and well classified. The database section follows logically and includes relevant physical findings, laboratory data and the results of ancillary investigations. The management plan completes each problem, and finally several current references are given. In addition, the book offers features that are not available in similar manuals: a section on bedside procedures that is quite well illustrated and provides easy reference before the reader performs a procedure that he or she may not have done recently; a list of possible complications that will assist in obtaining informed consent; an extensive list of medications that includes notes on side effects; sections on mechanical ventilation, blood component therapy, and laboratory values and their interpretation; and very useful appendices that include the calculation of creatinine clearance, an equivalence table for steroid doses and flow charts for cardiac resuscitation (the charts might have been more useful inside the front and back covers). I have only two criticisms of note. The discussion of seizure management does not warn of the frequent need to intubate the paLE 15 FEVRIER 1992
tient when the sequential use of diazepam and phenobarbital leads to respiratory depression. The reference given with the problem of hemoptysis, The Medical Book of Lists,' is no more informative than the book in hand. Overall, once the reader becomes accustomed to the problem-oriented approach this book takes he or she will find it an excellent pocket manual for evaluating on-call problems. Douglas A. McKim, MD, FRCPC Division of Respirology Ottawa General Hospital Ottawa, Ont.
Reference 1. Greenberger NJ (ed): The Medical Book
of Lists, 3rd ed, Year Bk Med, Chicago, 1990
The patient as team player
quently she refers to her own experiences to make worthwhile points. There are many useful practical lessons - for example, on inhaler technique and on comparison shopping for peak expiratory flow meters and drugs. At all times the author is very respectful and appreciative of the role and dilemma of the physician in this day of better-educated patients. Two of the most helpful chapters are "How to Work with Your Doctor" and "Compliance - Being a Team Player." They emphasize the patient's responsibility in helping the physician improve the patient's life. The book does, however, have some flaws. Harrington introduces but does not give enough prominence to prophylactic treatment with anti-inflammatory drugs, the advantages of inhaled steroids and how to properly monitor asthma with symptoms
as well as peak expiratory flow measurements. She promotes anticholinergics as calcium blockers and mast cell stabilizers, and she reports that steroids make ,B-sympathomimetic receptors less sensitive. Some of the language would require the use of a dictionary. Finally, the book often relates more to practices in the United States, where specialists are more likely than family physicians to treat asthma, in contrast to the situation in Canada. The new concepts promoted here and the practical hints on how to seek advice and to use medication and exercise make the book of value, but only to the well-motivated, well-educated patient with some knowledge of medical terminology. Dennis M. Bowie, MD, FRCPC Department of Respirology Victoria General Hospital Halifax, NS
The Asthma Self-Care Book: How to Take Control of Your Asthma. Geri Harrington. 272 pp. Harper Collins Publishers, New York. 1991. $26.95. ISBN 0-06016584-7 _D
irected at educated people with asthma this book . _ is well researched, easy to read and well organized. From the beginning the newer concepts of patient responsibility and of the physician's role as educator of the patient are promoted. Harrington encourages patients to be responsible for the care of their disease and gives helpful hints as to how they can get the best care from physicians, pharmacists and other health care professionals. She dispels the myths about anxiety causing asthma and exercise being harmful to the person with asthma, and she encourages patients to be members of the health care team and to prepare for exacerbations. FreFEBRUARY 15, 1992
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