Book Reviews

Ophthalmology for the Primary Care Physician

Edited by David A. Palay and Jay H. Krachmer. Pp. 318. Price, $59.95. Mosby, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318, 1997.

This relatively brief, soft-cover textbook is written by ophthalmologists for primary care physicians. It is intended to “allow the practicing physician to quickly diagnose ophthalmic disease and to treat if necessary or refer for further evaluation and treatment.”

The book is successful in meeting this goal. It begins with an overview of the eye examination, focusing on the areas most useful in primary care. Following is a chapter on ophthalmic differential diagnosis that reviews common symptoms and describes their most likely etiologies. The remaining chapters review abnormalities of the major structures of the eye, including the eyelid, conjunctiva, cornea, sclera, lens, uveal tract, retina and orbit. Specialty chapters (glaucoma, neuroophthalmology, pediatric ophthalmology and ocular trauma) are also included.

All of the chapters have a similar organization and lend themselves easily to quick reference or review. Each chapter begins with a brief review of the pertinent anatomy, followed by a section on abnormalities for that part of the eye. Most chapters are easy to follow and are organized in an outline format including the following topics: symptoms, signs, etiology, associated factors, differential diagnosis, workup, treatment, and prognosis. For the majority of topics, the sections contain enough information to be relevant and useful, without bogging the reader down with unnecessary details. Primary care treatment options are offered where appropriate, and indications for subspecialty referral are outlined.

This textbook benefits significantly from over 300 excellent illustrations, the majority of which are in color. These include clear anatomic drawings as well as an outstanding collection of ocular photographs that beautifully illustrate the major points made in the text. Many of the close-up photographs are the best I have seen of the pathologies represented. They are clearly labeled, well organized and demonstrate the subtle differences of the abnormalities being compared.

Since the time that I received the book for review, I have used it frequently for making differential diagnoses and discussing ophthalmologic topics with residents. Nearly all of the chapters contain multiple clinical pearls. The chapter on pediatric ophthalmology is particularly well written and more helpful than any I've seen in other primary care ophthalmology textbooks. It reviews normal development of the visual system and screening for the most important abnormalities. It then describes the most common congenital anomalies and ocular disorders with enough detail to allow for appropriate treatment or referral of the child, as well as suitable education for the parents.

The book concludes with a helpful chapter on ophthalmic medications. It is organized in tabular form and begins with a listing of the most commonly used ocular drugs. It is then divided into clear, useful tables of the various drug categories (e.g., dilating drops, artificial tears, antibiotics, etc.). Each lists the generic, trade names, typical dosage and other pertinent information. This chapter will help physicians identify unfamiliar medications taken by patients who are seeing an ophthalmologist and select therapeutic options from those recommended earlier in the text.

This textbook will serve as a useful review and quick reference for residents, medical students and family physicians in practice. The relative brevity makes it easy to read in its entirety during a clinical rotation, and the organization allows specific clinical entities to be rapidly located by busy physicians.

Readers of this textbook will be prepared to provide better primary eye care to patients, and to diagnose patients with serious eye conditions who need referral to an ophthalmologist.

A Textbook of Family Medicine

By Ian R. McWhinney. Pp. 448. Price, $34.95. 2d ed. Oxford University Press, 198 Madison Ave., New York, NY 10016, 1997.

This second edition of this classic textbook holds promise for everyone interested in general practice, family medicine and primary care. In Part I, “Basic Principles,” the author provides an excellent review of the scientific and philosophic foundations of family medicine. His perspectives on doctor and patient, science and practice, and health and disease, are both familiar and refreshing. Students will understand the principles of family medicine: competence, comprehensive care, continuity, and context of family and community. Postgraduate trainees will learn how the family physician integrates information and orchestrates solutions to complex problems. Practitioners will see how patient-oriented, evidence-based family medicine offers care that is successful, efficient and fulfilling. Scholars will face fundamental questions, find a broad spectrum of information and have their curiosity rekindled.

Part II devotes a chapter to each of several common problems in family practice: acute sore throat, headache, fatigue, hypertension and diabetes. Rather than the usual review of disease or guide to treatment, these chapters define the natural history of the problem as it presents in primary care and explore the role of the family physician in managing the patient and the illness.

Part III, “The Practice of Family Medicine,” discusses the process of care: home care, records, referrals, other health professionals, community resources, alternative medicine and practice management. These chapters, although brief, are clear and thoughtful and address key issues from the perspective of the family physician.

This textbook is not so much a reference text for a day in the office as it is a reference point for a career in the specialty. It is a guidebook for the reflective practitioner. As we grow more concerned with hassle factors than clotting factors and as we see community resources displaced by corporate profits and committed professionals treated like commodity products, it is good for family physicians to be reminded of our roots and our wings: value and virtue endure.

Why own a family medicine textbook? Often such texts cover many subjects superficially. Some cover a scattering of subjects well, while others wallow in thick theory. Like a good family physician, a good textbook should demonstrate breadth and depth, exploit both the richness of the biopsychosocial model and the rigor of biomedical knowledge, solve practical problems and ask sharp questions. A good textbook must also recognize and celebrate the uniqueness of a family physician. The author, Ian McWhinney, M.D., meets these challenges with erudition and eloquence, intelligence and insight. I don't have one of those big textbooks on my desk at the office. I keep this small one on my reading stand at home.

What job will this textbook help busy family physicians do better? Understand their patients, their science and themselves. What other job is there?

Infections in Pregnancy

Edited by Larry Gilstrap III and Sebastian Faro. Pp. 345. Price, $79.95. 2d ed. Wiley, 605 Third Ave., New York, NY 10158, 1997.

This textbook on infections in pregnancy is a readable resource for family physicians practicing obstetrics. The authors contend that their purpose is not to create a league of infectious disease experts, but to give “a basic understanding of the pathogenesis, diagnosis, possible adverse fetal and newborn effects, and treatment of the more common infections encountered during pregnancy.” By discussing the range of infections from candidiasis to babesiosis, the authors largely succeed.

The textbook begins with a section containing general information on the microflora of the genital tract and antibiotic use in pregnancy. Several chapters that follow cover common infections such as acute chorioamnionitis and postpartum endometritis. The ensuing chapters address specific types of diseases such as syphilis and herpes.

The organization of the individual chapters varies, but each chapter ends with a summary of salient points. The summary and the liberal use of diagnosis and management algorithms allow for quick scanning of the contents of the chapter.

The strengths of this textbook are its readability, the breadth of infections covered and the ease at which information is gleaned from the chapters. Readers should be prepared for the level of detail provided, as it is greater than the average family practitioner needs. In addition, the occasional lapse into a litany of studies gives the appearance that the authors may be aiming to create a league of experts after all.

A final consideration is the fact that the treatment of infectious diseases is constantly evolving so that treatment recommendations may not be current. For instance, since the publication of this book, the Centers for Disease Control and Prevention has released a new set of treatment guidelines for sexually transmitted diseases. In the chapter on vaginitis, the treatment listed in the algorithm for bacterial vaginitis is clindamycin 2 percent vaginal cream, which is no longer advocated. While this book can be used as a reference text for the pathogensis of infections, the practitioner needs to supplement it with more recent reference materials.

In summary, while I would not recommend this as a core reference textbook for physicians practicing obstetrics, it may be a useful addition to an existing reference library.

Software Reviews

Core Curriculum in Primary Care: Preventive Medicine CD-ROM

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

Core Curriculum in Primary Care (CCPC) is a user-friendly computerized program on CD-ROM that is designed to educate primary care physicians in four specific areas of adult preventive medicine. The program is available for use on both Macintosh and PC systems. The CD-ROM lecture series is sanctioned by the American Medical Association.

The CCPC (part 1, second edition) is an interactive multimedia CD-ROM program created from a live lecture series that covers four important areas of preventive medicine: cholesterol and the risk of coronary artery disease; prevention and treatment of obesity; adult disease; and the prevention of illness through vaccination and nutritional assessment. This particular CD-ROM program was compiled from lectures by leading experts from Harvard, Tufts University, Boston University and the University of Massachusetts and is available for review in audio and text formats.

Each lecture begins with a clear outline of the instructor's teaching objectives. The lectures are understandable, easy to follow and present accurate, up-to-date information on each topic. These tutorials focus primarily on covering the background, risk factors, epidemiology, prevention and treatment of each illness. Since the program is designed from a live lecture series given to an audience of primary care physicians, the user may find the presentation to be somewhat repetitive and lengthy. This also applies to the text format of the CD-ROM, which faithfully reproduces each word from the live lecture series without editing of unnecessary or superfluous words or phrases. This makes the review of the CD-ROM in the text format tedious and time consuming, compared with the audio format.

The CD-ROM contains a self-assessment quiz at the end of the disk that allows the reviewer to assess his or her mastery of the objectives presented by each of the lecturers. A Web site address provided on the back of the disk jacket allows the reviewer the opportunity to ask the presenting faculty specific questions about the information presented in the lecture series.

Also Received

A Child's Eyes: A Guide to Pediatric Primary Care

By John W. Simon and Joseph H. Calhoun. Pp. 223. Price, $39.95. Triad Publishing, P.O. Box 13355, Gainesville, FL 32605, 1998.

A Practical Guide to Communication Skills in Clinical Practice (CD-ROM)

By Robert Buckman, Barbara Korsch and Walter Baile. Price, $175.00. Medical Audio Visual Communications, P.O. Box 84548, 2336 Bloor St. W., Toronto, Ontario, M6S 1TO, Canada, 1998.

Blood

By John F. Dailey. Pp. 576. Price, $54.00. Medical Consulting Group, P.O. Box 1558, Arlington, MA 02474, 1998.

Bone Density in Clinical Practice

By Sidney Lou Bonnick. Pp. 259. Price, $89.50. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1998.

Breastfeeding and Human Lactation

By Jan Riordan and Kathleen G. Auerbach. Pp. 874. Price, $89.95. 2d ed. Jones & Bartlett, 40 Tall Pines Dr., Sudbury, MA 01776, 1999.

End Your Carpal Tunnel Pain Without Surgery

By Kate Montgomery. Pp. 144. Price, $14.95. Rutledge Hill Press, 211 Seventh Ave. N., Nashville, TN 37219, 1998.

Gastroenterology Electronic Reference and Review (CD-ROM)

By Tadataka Yamada, David H. Alpers, Chung Owyang, Dan Powell and Fred Silverstein. Price, $395.00. Lippincott-Raven, 227 E. Washington Sq., Philadelphia, PA 19106, 1997.

Lyme Disease

Edited by Daniel W. Rahn and Janine Evans. Pp. 254. Price, $35.00. American College of Physicians, Book Program, Independence Mall West, Sixth St. at Race, Philadelphia, PA 19106, 1998.

Management of Prostate Diseases

By Robert E. Weiss and William R. Fair. Pp. 141. Price, $17.95. 2d ed. Professional Communications, 400 Center Bay Dr., West Islip, NY 11795, 1997.

Mayo Clinic Cardiology Review

Edited by Joesph G. Murphy. Pp. 724. Price, $89.00. Futura Publishing Co., 135 Bedford Rd., P.O. Box 418, Armonk, NY 10504-0418, 1997.

Osteoporosis: Prevention, Diagnosis and Management

By Morris Notelovitz. Pp. 224. Price, $17.95. 2d ed. Professional Communications, 400 Center Bay Dr., West Islip, NY 11795, 1997.

Practitioners Guide to Psychoactive Drugs

By A.J. Gelenberg. Pp. 568. Price, $49.50. 4th ed. Plenum Publishing Corporation, 233 Spring St., New York, NY 10013, 1998.