Authors: Robert Turner, Brian Angus, Ashok Handa and Chris Hatton
Around ten years ago, white coats as worn by doctors and medical students became an increasingly rare sight on hospital wards. Awareness that these garments acted as miniature microbiology labs, spreading MRSA and C. difficile from patient to patient, led to a move towards a "bare below the elbows" culture of infection control that effectively relegated the white coat to a rag-week prop. However, these coats were equipped with deep pockets that immediately became filled with X-ray and blood request forms, handover sheets, takeaway menus and tourniquets. These pockets would also inevitably contain at least one pocket book - a handy reference that could be surreptitiously dipped into during particularly challenging ward rounds or when faced with an unexpected test result.
Clinical Skills and Examination is just such a book. It contains handy appendices with reference values for common and not-so-common pathology tests, cardiac arrest algorithms, vision assessment charts and, somewhat incongruously, the General Medical Council's Duties of a Doctor (2004) guidelines.
The main body of the text is divided into two main sections. The first deals with history-taking and examination skills, while the second focuses on clinical investigations and practical skills. It is this second section that is probably the book's main strength. The practical procedures tested in objective structured clinical examinations (OSCEs) are each described in a step-wise fashion, explaining the learning points and detailing the routine that should be followed. While there is no substitute for actually doing these procedures in a clinical environment, the routines that the book suggests act as excellent aides-memoires in the lead-up to exams.
The other parts of this second section contain good, concise summaries of investigations that patients may have to undergo (such as endoscopies or radiological tests), allowing the student to gain some appreciation of what diagnostic tests actually involve. The chapter on cardiology investigations, especially ECGs, is noticeably more detailed than some of the other chapters in this section.
The first section of the book consists of a series of system-based routines for taking a history and performing an examination. There are often nuggets of clinical information contained within these routines that do not always seem appropriate. Should a section about "problem patients" appear in the mental state examination chapter, for example, and are cafe-au-lait spots really a "common" skin disorder? The colour pictures are also on the small side, but the templates for good note-taking are an excellent resource that I would have appreciated as a student.
Who is it for? Medical students in their clinical training.
Presentation: Generally clear, but information is not always easy to find.
Would you recommend it? Not as a stand-alone text, but definitely as a pocket reference.