You will never examine a patient the way you did at Final MB again. Ever. OK, maybe you will at MRCP. Then never again. The examiner who expects you to examine that way never ever does it that way himself, either.
That is one of the premises, recognised by many but never discussed in polite company, on which this book is based. It does exactly what it says on the back cover: aimed at student and junior doctors who want to pass examinations, each chapter takes a system and applies common sense to history and examination as needed. Among the highlights are a breakdown of JVP assessment which actually makes sense and a critique of the nonsense that is coffee-grounds vomiting. Importantly, having established what is needed to pass an exam, he then distils history and examination techniques and makes them relevant to real life needs.
In an attempt to extend the remit of the book- to give young clinicians an insight into clinical medicine as a lifestyle, and to appeal to older, more cynical physicians- each chapter begins with a commentary on the character defects of those who practice within each specialty. These where good are very good: the cardiology chapter gives a novel and interesting insight into the large stethoscope favoured by heart doctors. On the other hand the usual clichés are trotted out about neurologists and, like a third year medical case, the book runs out of steam badly towards the end. While the author's difficulty with endocrinologists is intended to make that chapter amusing, it turns out neither very big nor clever. The author's best ever medical joke- felt to deserve a chapter to itself- is trumped weekly at any Northern Ireland endoscopy list or discharge planning meeting, and indeed by the author's own haematology chapter: concise and highly focussed, it should be published separately as a laminated sheet for all doctors over forty to reassure them that it's not just them- things really have gone to pot. Many asides, published as footnotes, often serve only to irritate.
These criticisms aside, there is plenty to like about this book, which strikes many chords. All physicians will appreciate the concept of internal medicine as a noble specialty under siege, illustrated by the trauma case dumped by A&E in the medical ward because he was thumped probably because he fell out with someone probably because his diabetes was unstable.
Cardiologists, respiratory physicians, gastroenterologists and rheumatologists, probably neurologists, and probably not geriatricians or endocrinologists will recommend this book to their students and junior grades who want to pass examinations and who want to be able to assess patients effectively (not necessarily the same thing). Less invective aimed at endocrinologists and a more selective use of footnotes when the second edition is prepared will extend its appeal even further.