Churchill's Pocketbook of Differential Diagnosis
Andrew T Raftery and Eric Lim
Churchill Livingstone, 2000;
£16.95
ISBN 0 443 06260 9
Rating: 3/4
The best way to evaluate a new book is
to use it. So for the past two weeks I
have carried this little text around
with me in my white coat, leafing through it
while waiting for a clinic to start or to help
me write patient portfolios.
This 500 page text centres around signs
and symptoms that patients present with to
us as health professionals. There is no chapter
on cardiac failure, though there are numerous references to it via the associated signs
and symptoms that patients exhibit - for example, leg swelling, oedema, dyspnoea,
hepatomegaly, weight gain, and so on.
This might put you off at first glance, but
when clerking a patient who is having trouble breathing, it is useful to have a quick look
to see how many of the 23 listed causes you
can exclude in the history and in your
examination. In addition to this if you have
to write about the patient your list of differentials will be better, and you will learn to
associate certain signs and symptoms with
specific diseases.
Following on from the table of differential causes of the sign or symptom in
question, the book outlines which aspects of
the history need to be explored and the salient features to find on physical examination.
It also goes on to discuss which general
(routine) and specific investigations would
be appropriate. There is no mention of
management in this text, which is a pity,
though this is obviously outside its remit.
As finals draw closer, my ward partner
and I have found this book useful in testing
our knowledge. We pose a question, such as,
"A patient presents who has collapsed. What
are your differentials, how would you
exclude some of these, and what are the
appropriate investigations?" and work our
way through the chapter. The coverage is
more than adequate, and I have not yet
found any physical signs or symptoms that
have been missed out.
Unless you already know 16 causes of
hiccups and how to differentiate between
these at the bedside I think you should get
hold of this book. I imagine it will be more
suited to senior medical students and will
continue to be a valuable aid to my clinical
education and as a revision tool.
James S Dawson, fifth year medical student, Leicester University
Email: jsd7@le.ac.uk
studentBMJ 2001;09:85-128 April ISSN 0966-6494
