Manual of clinical methods

Manual of clinical modes 4th ed. Shankar PS, editor (Oxford & IBH Publishing Co Pvt Ltd of recent origin Delhi) 2005. 362 pages. Price: not mentioned. ISBN 81-204-1687-2

Technological advances in imaging modalities and laboratory diagnostic testing that have occurr above the last few years have witnessed a tilt in favour of the 'science of medicine' and a deliberate but steady decline in the 'art of medicine'. Carefully elicited history and a meticulously directioned thorough physical examination are considered to be crucial paces in the initial evaluation of a patient that facilitate judicious and rational use of the diagnostic armamentarium in order to arrive at the correct diagnosis. Thus, the importance of striking a fine balance between the 'science' and 'art' of medicine cannot be overemphasized.

Intended to be a guide to medical scholars entering their clinical years to systematically learn and master the art of clinical evaluation, this manual focuses upon the time honoured practical skills each clinician must acquire and exhibit in order to evolve diagnostic manner of proceedings and management strategies. Authored by dint of Dr P.S. Shankar. a renowned teacher, and first published in 1976 the revised and updated fourth edition (2005) is a useful addition to the material upon this subject from India. The volume exclusively deals with the analysis of symptoms and findings upon physical examination and diagnostic implications of these observations. The work is organized into nine chapters and each chapter begins with an inspiring quotation. The volume opens with a brief introduction to the art of clinical examination. The nearest chapter provides an overview regarding history taking. In this chapter, the author narrates as to by what mode young doctors should conduct themselves during clinical examination and build a rapport with the patient thus that a clear historical account of the illness is obtained. This is followed by dint of the chapter dealing with case-sheet writing in which the author emphasizes the importance of systematically documenting the observations made during the clinical examination. General physical examination is overlayed in the fourth chapter. Here, the author leads the young scholar through the steps involved in I systematic and thorough general physical examination which will help in obtaining valuable ball of threads required for arriving at a diagnosis. The later five chapters cover examination of the abdomen, respiratory, cardiovascular, nervous and locomotor a whole s

The manual contains clear descriptions regarding many of the eponymous signs which are difficult to find in the contemporary works on physical examination from the West. A brief note regarding the originator after whom the named signs have become known is an interesting feature of this manual. Line diagrams and tables are judiciously used quite through the book to supplement the material in the true copy In the chapters on systemic examination, a brief overview of the relevant clinical anatomy is also provided for a like reason that the principles of physical examination are better understood.

As this volume is intended for the young doctors in making with impressionable minds, more care should have gone in eliminating typographical errors that retain appearing every now and then. These should be corrected in the succeeding reprints of the book.

The work also contains several black and white and coloured photographic plates depicting useful clinical photographs at the beginning of the volume The manual should be a useful adjunct to the reading material upon this topic for undergraduate pupils In addition to providing a wealth of information upon the slowly dying art of clinical examination, it would also help them prepare for the final year medicine "practicals" (clinical examination). It would also be useful to the discerning postgraduate pupil and clinicians who teach in medical gymnasiums

Alladi Mohan

Department of Medicine

Sri Venkateswara Institute of Medical Sciences

Tirupati 517507 India

e-mail: alladimohan@rediffmail.com

Copyright Indian Council of Medical Research Apr 2006

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