Volume 193 - Issue 3
How to examine patients
Author: Timothy P Usherwood
Med J Aust 2010; 193 (3): 180. || doi: 10.5694/j.1326-5377.2010.tb03842.x
Published online: 2 August 2010
Published online: 2 August 2010
Clinical examination. A systematic guide to physical diagnosis. 6th ed.
Nicholas J Talley, Simon O’Connor. Sydney: Churchill Livingstone, 2010 (xviii + 478 pp). ISBN 9780729539050.
“Talley and O’Connor” just keeps getting better. Written by Australian clinicians Nicholas Talley, currently Professor of Medicine and Epidemiology at Mayo Clinic in the United States, and Canberra-based cardiologist Simon O’Connor, the book was already an accessible and thorough guide to physical examination. Each successive edition brings extra features.
This sixth edition has tables of differential diagnoses for abnormal signs, more anatomical illustrations, and new sections on “examination anatomy”. There is useful advice on the examination of patients with a variety of important or common problems, and coverage of examination of the eyes, ears, nose and throat has been expanded. Many of the photographs of pathological signs and of physical examinations are clear and memorable.
The art of physical examination is evolving into a quantifiable science, and this edition adds information about interobserver reliability to the very important positive and negative likelihood ratios for key physical signs.
The accompanying DVD contains sequences illustrating a systematic approach to physical examination, hints on objective structured clinical examinations with suggestions for a more focused approach to a wide range of clinical problems, and libraries of images and electrocardiograms. The libraries would be useful for revision and self-testing as the accompanying text can be turned on or off. A website allows the full text to be searched online.
Inevitably, I have some criticisms. The paragraph on taking a history of illicit drug use is overly short and omits important issues. And if the patient was lying on a low bed, as in the DVD, I would prefer to palpate the abdomen from a sitting or kneeling position — or raise the bed! The escalating assessment of suicide risk should include questions about acts, not just feelings, thoughts and plans. But these are mostly minor points. The book remains excellent value for money, is a sound guide for students, trainees and more experienced clinicians working beyond their speciality, and is highly readable with a leavening of sly humour.