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The Oxford English Dictionary defines diagnosis as: 'Identification
of a disease by careful investigation of its symptoms and history'
. Regrettably, the value of the history in the diagnosis of disease
often seems to be neglected in both undergraduate and postgraduate
medical education. The considerable advances in medical technology
have made it easy to carry out a multiplicity of tests. As a
result, there is frequently an unfortunate tendency to rely on the
results of tests before decisions are taken on diagnosis and
treatment, even though such tests are often of limited value in the
manage ment of the patients. This book is an attempt to redress the
balance and place the proper emphasis on the diagnostic value of a
well-taken and perspicacious history. The main purpose of the book
is to show that most of the clinical problems encountered in daily
practice can be dealt with effectively and satisfactorily on the
basis of a good clinical history. This should be supplemented by a
prob lem-orientated clinical examination, the primary function of
which is either to confirm and amplify the diagnosis provided by
the history, or to refute it."
Herewe offer anew approach to understanding and managing common
medical conditions. With the needs of our readers in mind we
present clearer, more extensive and more expansive views on them.
Traditional medical textbooks are wordy tomes with well worn
patterns dealing in set order with 'causes, symptoms and signs,
diagnosis and treatment'. They offer formal instant snapshots of
diseases. We have devised an economic synoptic style, and we have
endeavoured to give acomprehensive and an on-going long term
movepicture ofeach condition and to relate this to the
analysisofsymptoms and signs, to diagnostic assessment and to
management and treatment. We have selected 22 important conditions
and for eachhave followed the same sequence of questions and
answers: * What is it? giving a brief summary of the current
understanding of the nature of the condition. * Who gets it when?
showing the age-sex distributions and influence ofother factors
such as social class, international comparisons,
andtheirlikelyfrequency ingeneralpractice and at the district
general hospital. * What happens? analysing the significance of
symptoms and signs, the likely course and outcome and how these
influence care. * What to do? an appreciation of the nature and
presentation of the condition, and their relevance to diagnosis and
management.
Why yet another book on clinical diagnosis? The profusion ofmedical
text booksfor studentsand young postgraduates is known to all ofus,
and so also is the time-consuming and frequently frus- trating
search in these books for the relevant facts we need, so often sub-
merged in a mass of information which we do not really require. The
traditional textbook that most clinicians have used in their
training may well be written in the leisurely, discursive and
unstructured style much loved by our teachers of old, but perhaps
out of place in modern medical education where knowledge is so
rapidly expanding and time available for its assimi- lation rapidly
contracting. It iswith these considerationsinmindthat wefelt
itwould beusefulto pro- vide a clear, concise, easily readable and
well-illustrated book on the essen- tials of clinical diagnosis.
Each chapter deals with a medical problem commonly encountered in
dailyclinicalpracticeand beginswith alistofthepossiblecausesand
apracti- cal perspective of their prevalence in general practice
and in hospital prac- tice; the age distribution and the
clinicalsignificanceofthe various disorders is also pointed out.
The majorpartofthe chapter isconcernedwith thediag- nostic approach
to the particular problem and emphasizes the importance of
symptomsand signsin reachingthecorrectdiagnosis, as well asthe
value and limitation of the investigational approach to the
diagnosis. The book emphasizes the fundamental clinical skills
ofhistory-taking and clinicalexamination in diagnosis, so
frequently and mistakenlysubordinated to the investigational
approach which is often disappointing in the limited diagnostic
help which it does provide.
Backing up the pioneering medical researchers and experi menters
are the phalanxes and cohorts of practising clinicians in district
general hospitals and in general practice who may have to implement
and apply any breakthroughs and advances in practical and realistic
terms. This they cannot, and should not, be expected to do without
careful consideration and analysis. It is essential, therefore, to
have regular reviews of the growing points of medicine which are
constructively critical as well as being enthusiastic and which can
present the issues and implications clearly and fairly to
clinicians. The Practical Clinical Medicine series is designed to
provide such regular reviews on selected subjects. Each volume is
under the charge of an invited editor who selects his team of 4-6
experts. Each contribution is an authoritative, detailed and
referenced examination of his topic, is clearly presented in an
understandable manner and is practical, relevant and applic able to
everyday clinical practice. The series is intended as a means of
communication between researchers and practising clinicians. It is
dedicated to gener alists who provide primary health care in
general practice and to generalists providing secondary medical
care in district vii viii Series Editors' Foreword general
hospitals. Both are involved in applying good general practical
clinical medicine for their patients, but can only succeed in a
climate of constant review and examination."
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