Despite its stated objective of appealing to junior trainees (residents), I believe this book should not be used as an introduction to anaesthesia. Rather, it should be used to embellish the basic knowledge that is necessary for clinical decisionmaking in senior trainees preparing for Final Fellowship or equivalent level exams. It will certainly be a strong support to practising clinicians, who constantly need to keep up-to-date with the plethora of available data in the literature. More than that though, the clinician aspiring to maintain quality CEPD should find that this textbook enriches a reflective practice by not only bringing together the best relevant knowledge, but does so in a manner which acknowledges the conflicts and balances of individual risk –benefit assessment which are the bedrock of effective clinical practice. D. J. Buggy Dublin, Ireland E-mail: [email protected]
Oxford Handbook of Clinical Specialties, 9th Edn. J. Collier, M. Longmore and K. Amarakone (editors). Published by Oxford University Press. Pp. 842. Price £30.00. ISBN 978-0-19959118-3. As a fourth-year medical student, I have had the eighth edition of the Oxford Handbook of Clinical Specialties (OHCS) for around 2 yr now: it is battered, bruised, bits of the plastic are peeling off, and most of the Orthopaedics section has fallen out. You may take this as an example of how much use I have derived from it, rather than a commentary on durability. The Oxford Handbook of Clinical Medicine (OHCM) has long been an essential guide for medical students and junior doctors alike, and I imagine you would be hard pressed to find a GP surgery or hospital ward without at least one copy of it, often badly worn, inevitably not the most recent edition, but still referenced daily by the throngs of juniors and students. The first edition of the Oxford Handbook of Clinical Specialties was published only two years later than the OHCM, but somehow never attained the same ubiquity. The ninth edition contains the same eclectic mix of a dozen chapters as the previous edition, covering 11 medical and surgical specialities and a chapter on eponymous syndromes. At first glance, this may appear to have been assembled at random, but on closer inspection, the chapters actually complement each other flawlessly. The layout of the ninth edition is broadly similar to the eighth, although it is now more flamboyantly coloured, blue or red adorning every page margin as opposed to lilac and pink. The same vibrancy of colour is applied to the 400 or so images adorning so many of the pages, which makes the book more attractive, yes, but also serves to make the multifoliate radiographs, CT slices, MRIs, and photographs easier to see. Unlike the eighth edition, I never felt I had to hold this edition two inches from my face to see what was (apparently)
abnormal on a radiograph. The benefit of the higher quality printing is most apparent in the dermatology and opthalmology sections. More prominent, in the top left of most pages, is a system of crosses, indicating the author’s perceived importance of a topic. The system ranges from 0 to 3, with three representing key topics within a field. It is designed so that first-time readers can prioritize their reading of a handbook that contains more than 800 pages. This allows the reader to get a basic overview of a speciality more rapidly by allowing them to focus on the most important topics during the first time of reading and this generally works well. As one would expect, the content of the ninth edition has been updated to include new evidence, changes in practice, and recent NICE guidelines. Each page contains an overview of a condition, that is concise and to the point, which is supplemented by footnotes, boxes containing extra information, flow charts, and illustrations. Inevitably in certain subjects—especially the paediatrics, obstetrics, and gynaecology sections—the aspiring student requires more depth for their clinical attachments than the OHCS could hope to provide, but as a quick reference tool, it is infallible. The amount of overlap between some of the specialties is significant. For example, I gained a better appreciation of the multidisciplinary issues of Labour Ward case management by the fact I had a reference workon obstetric and gynaecological conditions, with paediatric and anaesthetic management strategies discussed alongside. The anaesthesia section contains a brief but comprehensive overview of the practical conduct of anaesthesia. Although I personally found it somewhat lacking in detail regarding the pharmacology of the drugs anaesthetists use daily, it still goes a long way towards providing an overview of the speciality, which is sorely lacking in most textbooks relevant to a medical student. Pre- and postoperative preparation for surgery is also covered with a useful discussion of the risks of anaesthesia. The Primary Care section is altogether different from the others, containing little in the way of hard clinical facts, but a lot of practical information with sections covering everything from performance monitoring to smoking cessation. Unusually for a textbook, there is self-professed ‘unique philosophy’ running throughout it, outlined in the preface. It attempts to highlight examples of good ethics, through discussion and anecdotes from the authors interspaced through the more objective pages. The ninth edition is an incremental advancement over the previous version. The updated information, improved layout, and better quality of illustration are all improvements one would expect. The content remains of the same high quality, and the holistic philosophy of the authors is interesting to read. However, if you already own the eighth edition, there really is not much point buying this—a lot of pages are word-for-word identical to its predecessor. Students starting the clinical phase of their course will be the primary target audience, but this textbook would also be of value as a reference tool for anaesthetists, to allow an appreciation of the how surgery fits into the management of conditions that they
may not have been encountered since their own time at medical school. J. Hayes M. Wiles* Sheffield, UK *E-mail: [email protected]
Expert Decision Making on Opioid Treatment. J. C. Ballantyne and D. J. Tauben (editors). Published by Oxford University Press. Pp. 145. Price £30.00. ISBN 978-0-19-976888-2. Opioid prescribing for chronic pain continues to increase, despite the paucity of evidence in support. Indeed, the weight of evidence indicates that opioids prescribed for chronic non-cancer pain reduce function and prolong pain and disability. Yet, pain physicians agree that some patients do benefit, so how do we decide who to trial with strong opioids? This small book makes an admirable attempt to answer this difficult question. It is another in the Oxford University Press series on Pain Management and follows the compact format of its predecessors. The editors and most of the authors are from the USA, but this does not detract from its relevance to a UK reader.
The book consists of 12 short chapters and describes the use of opioids in different clinical scenarios, for example, pain after trauma, and pain associated with chronic debilitating disease. There is a chapter on opioids in cancer pain and chapters discussing complex problems associated with opioid prescribing such as a history of substance misuse and pain without a pathoanatomic diagnosis. Each chapter begins with a case history and this makes for a very readable format. The cases are well chosen and cover many of the problems that we see in the pain clinic, so the relevance is applicable beyond the case described. There is a useful chapter on tools to improve management such as questionnaires to measure pain, function, and disability and risk from opioids. The book concludes with a very helpful chapter from one of the editors entitled ‘Not a suitable candidate, saying no’. This is a useful book with a wealth of guidance for doctors dealing with a difficult patient group. It is suitable for doctors working in pain clinics and physicians in primary and secondary care who prescribe strong opioids for chronic pain. R. Atcheson Sheffield, UK E-mail: [email protected]