G. Sandler – författare

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.

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.

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.

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.

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.