Book Review

Primary Care of Women

N Engl J Med 1995; 333:1362-1363November 16, 1995

Article

Primary Care of Women
Edited by Karen J. Carlson and Stephanie A. Eisenstat, with Fredric D. Frigoletto, Jr., and Isaac Schiff. 557 pp., illustrated. St. Louis, Mosby, 1995. $69.95. ISBN: 0-8016-7677-0

Primary Care of Women is a book I turn to in the midst of a busy day in the office to find helpful answers to clinical questions. This book admirably fulfills its purpose: to be a concise, practical reference for clinicians engaged in the primary care of women.

The editors, who are experienced primary care physicians, and the associate editors, who are distinguished obstetrician-gynecologists, have a solid understanding of what primary care physicians need to know to provide comprehensive care to women. Their 83 contributors, predominantly from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, focus on important clinical topics.

The book is divided into four parts. Part 1 covers the common diseases, organized by systems, that present differently in women and men, are more common in women, or respond differently to treatment in women. These chapters present what is known and not known about these differences and indicate when this is likely to matter. For example, primary care physicians often share with obstetricians in the care of pregnant patients. The chapter on hyperlipidemia reminds primary care physicians that cholesterol and triglyceride levels increase during pregnancy and can remain high for up to a year after delivery, and the author wisely suggests that measurement of a woman's lipids be delayed until at least six months post partum.

Part 2 covers ambulatory gynecology, obstetrical problems that fall within the purview of primary care, and oncology. This part addresses the important question of when to refer patients to specialists and offers helpful guidelines for primary care physicians. Several excellent chapters, such as the one on pelvic masses, are each coauthored by a general internist and a gynecologist. Other chapters covering problems handled by both general internists and gynecologists, such as sexually transmitted diseases, might have been strengthened by such collaboration. The obstetrical section is particularly strong. Chapters that provide useful answers to patients' questions include those on preconception counseling and on the use of medications during pregnancy and lactation. The chapters on medical problems in pregnancy offer much succinct, helpful information about the appropriate management of common medical problems.

Part 3, on psychology and behavioral medicine, includes an excellent chapter on domestic violence, with clear, practical suggestions for diagnosis and management. This extremely important issue is often omitted in standard treatments of women's health.

The last part covers cancer screening and other issues in preventive care. The chapter on screening for breast cancer gives a balanced discussion of the evidence for and against screening women in their 40s and presents sensible overall recommendations.

The chapters in this user-friendly book follow a consistent format — they are clearly divided into sections on epidemiology, evaluation, management, pregnancy, and the disease under discussion, and summary sections. Cross-references to other chapters make it easy for the reader to find relevant information, and eliminate repetition. There are many useful tables, presenting information on differential diagnosis, evaluation, and treatment. The tables can be valuable teaching aids for physicians supervising residents in medicine and obstetrics and gynecology. The 10 color plates are illustrative and helpful, but the black-and-white photographs are dark and sometimes difficult to interpret. References are selective and up-to-date.

I recommend this book to all clinicians who provide primary care to women, including internists, obstetrician-gynecologists, family practitioners, residents, fellows, and nurse practitioners. This book passes the “definitely needed” test. I've come to depend on it.

Jane S. Sillman, M.D.
Brigham and Women's Hospital, Boston, MA 02115