Core Curriculum in Primary Care: Primary Care Ophthalmology, CD-ROM

By American Medical Association. Price, $99.95 institution, $49.95 individual. SilverPlatter Education, Inc., 246 Walnut St., Ste. 302, Newton, MA 02160-1639, 1997.

Physicians are caught between two kinds of learning: learning by following the advice and example of more experienced clinicians and learning by review of the literature and documented evidence. The first approach transfers wisdom but may be flawed by inaccuracies; the second transfers knowledge but lacks the personal influences that shape the art of medicine.

Now we have many means of disseminating information and computer technology provides a new avenue for learning. However, for all the advances that computers give us, with links to the Web or access to authors, this edition actually teaches by the old-fashioned mentoring method. It is, in fact, a slide show in your own home.

This program provides the user with a series of lectures on common ophthalmologic topics, presented by experts in the field. The topics are relevant: diabetic retinopathy, glaucoma, advances in eye surgery, the red eye, topical eye medication, ocular disease and its systemic manifestations. Viewing slides of eye disorders is a useful way of reinforcing the knowledge base in an area in which some primary care physicians may have limited training. The program allows a viewer to listen to the speaker, read a transcript of the speaker's text, and cull slides and information from the lecture to create new material for his or her own teaching purposes. For the more adventurous viewer, editing capabilities, home page access and other Internet linkages, as well as opportunities for questioning the speakers, are available.

On the other hand, the viewer should be aware of certain limitations of this program, which often occur in the context of conference lectures. The first is that the speakers provide information that may or may not be well organized or relevant. The result is that a section on commonly asked questions focuses at length on the pathophysiology of macular degeneration and then briefly addresses several questions about sunglasses and video display terminals—it does not present these “commonly asked questions” in an organized, topical fashion. The second limitation is that we are asked to rely on the opinions of the speakers. It is telling that although the viewer may click on a bar announcing references, none of the speakers provided any. Yet, surely such issues are more controversial than the speaker indicates and should be described against a background of other studies that have been done about each topic.

Despite these drawbacks, the old mentoring method of learning combined with modern technology allows the user to participate in the learning process. This active role may allow clinically useful information to stay with the reader more reliably than if he or she had perused a well-documented, evidence-based journal. Besides, the format allows the user to play with the possibilities offered, and, in the process, to strengthen skills that are likely to enhance clinical ability. Eventually the mentoring and the scientific method of learning will be in better balance.

Clinical Management of Poisoning and Drug Overdose

Edited by Lester M. Haddad, Michael W. Shannon and James F. Winchester. Pp. 1257. Price, $150.00. 3d ed. Saunders, Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, 1997.

This textbook is intended for practicing emergency physicians; primary care physicians in family medicine, internal medicine and pediatrics; and physicians in public health. The preface contains the authors' perspective of an increasing relevance for toxicology in our society (given the ravages of drug abuse, terrorism, and the frequent use of antidepressants) and notes that this edition has been expanded to include 10 additional chapters addressing new developments in medicine and toxicology. According to the preface, this edition has been almost completely rewritten and the efforts of a new editor, Dr. Shannon, are acknowledged.

The book contains two sections: “General Information” and “Specific Poisons.” The general information section addresses a broad range of subjects, including approaches to adult, geriatric, pediatric and pregnant poisoning victims. Also, effects of poisoning on specific organ systems are covered.

The section on specific poisons contains nine subsections: “Natural and Environmental Toxins”; “Centrally Active Agents”; “Analgesics”; “Antimicrobial and Chemotherapeutic Agents”; “Heavy Metals and Inorganic Agents”; “Pesticides”; “Inhalation Poisoning and Solvents”; “Cardiovascular and Hematologic Agents”; and “Herbal Medicine and Miscellaneous Agents.” The chapters are appropriate for a primary care physician audience and address poisonings by medications, environmental agents and nonprescription drugs commonly seen by primary care physicians with busy clinical practices. A brief appendix provides conversions of toxicologic laboratory values.

The chapters are well written, readable and contain accurate and current information. Tables are liberally used to increase information quantity and ease of retrieval. Information is easy to locate in most instances. Exceptions include whole or partial chapters that were inadvertently misplaced in the text: “Digitalis,” “Calcium Channel Blocker Poisoning” and “Beta-Adrenergic Blocker Toxicity” were misplaced in “The New Cardiac Antiarrhythmic Agents” and “The New Cardiac Antiarrhythmic Agents,”“Sympathomimetics,”“Ergot” and “Theophylline and Caffeine,” were misplaced in “Baby Powder, Borates, and Camphor.” Otherwise, chapters appear to be accurately referenced throughout the text.

I believe the textbook is well designed for its targeted audience. Its greatest value will be as a textbook for physicians needing general reference information and for primary care physicians who desire additional patient-related information beyond that supplied by poison control centers and other reference texts. It would be a good choice as the single poisoning textbook for libraries of practicing family physicians or primary care residency programs.