Problematic approach to O & G | |
Clinical obstetrics and gynecology. A problem-based approach. Alexander F Burnett. Malden, MA: Blackwell Science, 2001 (x + 462 pp). ISBN 0 632 04353 9. |
There is good evidence to support the use of problem-based methods as an effective way of teaching and learning. Medical textbooks have shifted to this approach, with an emphasis on the presenting problem rather than on disease classification. Unfortunately, in an effort to cover all of obstetrics and gynaecology, this book has mixed the problem-based approach with the disease classification.
The book does use clinical vignettes of common problems throughout each chapter. These would be of particular relevance to medical students, as the case scenarios add a refreshing perspective to the clinical problem, and maintain the focus on common disorders rather than rare conditions. Nevertheless, the book has some significant limitations. In its effort to remain problem- and clinically based, it lacks the rigour of evidence-based approaches. Thus, for a common gynaecological problem such as heavy and irregular menses there are no guidelines for which woman requires investigation. In attempting to cover all of obstetrics and gynaecology, there are some significant omissions. Although the teenager with acute bleeding is mentioned, the appropriate coagulation tests are not defined. Neither is it mentioned that coagulation screening in adults is still worth doing. Studies have shown that over 10% of adult women presenting with menorrhagia will have a bleeding disorder, so this is relevant. To follow this topic through, there is only limited information on the management options for menorrhagia. Some of the omissions may represent the fact that this is an American textbook and therefore options that are available here in Australia, with good evidence to support them — such as non-steroidal anti-inflammatories, transexamic acid and levonorgestrel intrauterine system — are not included. There were some errors which probably reflect the author’s expertise in gynaecological oncology, and lack of exposure to paediatric and adolescent gynaecology or gynaecological endocrinology. For example, women with Turner’s syndrome do not require gonadectomy unless there is evidence of Y chromosome material — unlike women with XY gonadal dysgenesis. My expectations of Clinical obstetrics and gynaecology were for a clearly written, practical book. I was not entirely disappointed, because, as an introductory text for medical students, it has some excellent sections. Unfortunately, the combination of the errors and omissions, the lack of evidence-based approaches, and the differences between American and Australian therapeutics, places significant limitations on its wider use. Sonia R Grover
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