Oxford Handbook of Clinical Diagnosis

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Oxford University Press, 2014 - Medical - 664 pages
Fully revised for its third edition, the Oxford Handbook of Clinical Diagnosis provides a concise and practical summary of the reasoning processes behind clear and confident diagnosis. The handbook is set out systematically with symptoms and signs through each specialty, and includes a detailed description of the basis of logical evidence-based differential diagnosis. This new edition has been updated with more straightforward diagrams aswell as brand new images to help aid understanding. Including rarer diagnoses alongside common conditions, and vital information about longer-term management alongside the initial treatments, thishandbook will ensure your excellence and confidence no matter what signs and symptoms your patient presents with. Providing practical help when dealing with problems outside your area of expertise or with unforeseen situations, you can be sure that this handbook will be the reader's perfect companion to sharp and self-assured diagnoses throughout their medical career

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The Oxford Handbook of Clinical Diagnosis is a gem of a reference work which can enhance the clinical practice of any doctor in any specialty and hone his or her reasoning skills. It also emphasises the value of experience and repetition in refining clinical assessment, so easily compromised by modern pressures. It's the same size as Eastham's Pocket Guide to Differential Diagnosis but much, much more comprehensive and of especial value to the junior doctor covering patients in several specialties.
For nearly a century, French's Index of Differential Diagnosis was unrivalled in helping doctors reach a diagnosis. With symptoms arranged alphabetically, the text helped readers identify the significance of each presentation, explaining the signs and tests used to make a confident diagnosis. It was updated in 2011 by Mark Kinirons and Harold Ellis with copious illustrations. A smaller book, of text only, had been produced in 1979 by R D Eastham – A Pocket Guide to Differential Diagnosis - of 467 pages listing every symptom by body system, each group followed by possible diagnoses.
The above approach - of recognising symptoms, signs and tests - was revamped and enhanced in 2006 by the Oxford Handbook of Clinical Diagnosis, which promotes the rationale behind the diagnostic process, even treating it mathematically. It packs a huge punch, restoring diagnostic acumen to its proper place, namely beside the patient with careful evaluation of the patient’s signs and symptoms.
Modern medicine is often taught or learnt by rote. Furthermore, consultations can turn into a disconcerting marriage of three parties, the computer too readily depriving the patient of eye contact with the clinician. This crystallises the dilemma facing the practice of western medicine, namely the decline in clinical skills whilst information available through the internet increases exponentially and is often accessed uncritically. The public can now go on-line with their symptoms, causing many anxious people to seek reassurance from healthcare professionals. Despite this, the time available for a doctor to make a confident diagnosis is reducing, undermining the long-established principles of a detailed clinical history, careful examination of the patient and scrupulous recording of the findings to provide a valuable baseline with the reasoning behind the putative diagnosis clearly laid out. The Oxford Handbook of Clinical Diagnosis excels with its rationale for evidence-based conclusions.
The handbook is very timely, as new standards for medical reporting have been developed by the Royal College of Physicians (RCP) Health Informatics Unit (HIU), supported by NHS Digital. With the advent of the electronic medical record, standardised medical record keeping will promote accuracy and facilitate data collection. Professor Iain Carpenter, clinical lead for records standards at the RCP HIU, says: “The quality of medical records is fundamental to the quality and safety of patient care, but at present there is no one agreed medical records standard in the NHS – each hospital has its own way of recording patient information. Mistakes and missing information in records are common and are a major contributory factor in medical errors and poor clinical care, leading to complaints and medical negligence cases.” Standardisation will reduce duplication and improve data collection.
I suggest that this handbook will go a long way to improving diagnostic skills and the quality of medical record keeping, easing the pressure on doctors who face the panoply of complexities from all specialties, particularly those covering large numbers of patients whether in general practice or a busy hospital. Buy it.

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About the author (2014)

Huw Llewelyn, Formerly Consultant Physician; Honorary Departmental Fellow, Kings College Hospital, London; Aberystwyth University, Ceredigion, UK,Hock Aun Ang, Honorary Senior Lecturer in Medicine; Consultant Physician and Endocrinologist, Penang Medical College; Seberang Jaya Hospital, Penang, Malaysia,Keir Lewis, Senior Lecturer in Medicine; Honorary Consultant Physician, Swansea University; Prince Philip Hospital, Llanelli, Carmarthenshire, UK,Anees Al-Abdullah, General Practitioner, Meddygfa Minafon, Kidweli, Carmarthenshire, UK

Huw Llewelyn qualified in Medicine at the University of Wales in 1970. In 1975 he became senior registrar and lecturer in medicine and endocrinology at St Bartholomew's Hospital London. In 1979 he was appointed Consultant Physician at King's College Hospital London. His MD was sponsored by the Nobel Laureate Sir James Black FRS and describes new theorems in probability theory that allow tests to be designed and assessed in a systematic way for differential diagnosis and identify patients who probably respond (or do not respond) to specific treatments. His clinical and teaching experience is based on work in university teaching hospitals in inner cities, rural district general hospitals and general practice. He is currently adapting the Oxford Handbook of Clinical Diagnosis so that it can be used by trainee doctors at Kettering General Hospital to write sophisticated electronic discharge and handover summaries that explain medical reasoning to patients and students.

Hock Aun Ang is a medical graduate from University College Cork, Ireland. After jobs in various medical specialties in the UK, he pursued Diploma in Tropical Medicine and Hygiene (Liverpool) and MSc in Infectious Diseases (University of London). Currently, as a Consultant Physician and Endocrinologist at Seberang Jaya Hospital in Penang, Malaysia, he is actively involved in the supervision of clinical specialists, medical officers and house officers, and the teaching of medical students from Penang Medical College.

Keir Lewis qualified from Guy's and St Thomas' Hospitals and after various jobs in North and East London, he completed his specialist training in Respiratory and General Internal Medicine in Wales. He has a First Class Intercalated BSc in Psychology and his current research interests include Sleep-Disordered Breathing (in which he did his MD Thesis) and Smoking Cessation.

Annes Al-Abdulla graduated from Baghdad University Medical School in 1977. He came to the UK in 1983 and started training in Chemical Pathology in 1985 first at Kings College London then at the Middlesex and University College, London Medical Schools. His last post was a lecturer and senior registrar in chemical pathology. During this period he obtained two master degrees from London University in General and Clinical Biochemistry and finished the examinations for the membership of the Royal College of Pathology, which was awarded in 1990. After this he decided to move into general practice and after a couple of years he was able to get a job as a full time general practitioner in Carmarthenshire. In 2000 he was awarded the fellowship of the Royal College of Pathology. Currently in addition to his job as a GP, he regularly covers for the absence of the local Chemical Pathologist and participates in two hospital diabetic clinics as a diabetes specialist.

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