Book Review

Women's Medicine

N Engl J Med 1996; 335:1615November 21, 1996

Article

Women's Medicine
Edited by Richard E. Blackwell. 644 pp., illustrated. Cambridge, Mass., Blackwell Science, 1996. $95. ISBN: 0-86542-373-3

This book was written in response to a survey of practicing obstetricians and gynecologists who were asked which problems would benefit from an update of information. Its sections are largely organized according to specialties: cardiovascular medicine, pulmonary medicine, endocrinology, neurology, gastroenterology, rheumatology, hematology, and infectious diseases, with others on selected problems in dermatology, otolaryngology, and psychiatry.

Each chapter stands alone, and the book seems less than the sum of its parts. It lacks a unifying theme and an introductory chapter on women's health and health care. Chapter 2 would have made a better initial chapter, since chapter 1, which seems mistitled (“Risk Factors and Screening”) is a list of problems prevalent among women, especially older women, rather than a discussion of the risks of screening and appropriate screening tests at different ages.

The sections are readable and informative but vary widely in breadth, depth, and detail. Each section would have benefited from a unifying introduction explaining the importance of the specific medical problem and the associated morbidity and mortality. Some authors are careful to discuss reasons for referral, but others ignore this important aspect of primary care; some chapters discuss too many rare possibilities and complexities. For example, the chapters on hyperlipidemia and coagulation problems are not well focused on primary care.

The boxes and tables are focused, specific, and useful. The index is excellent, but there are too many typographical errors in the text. The four chapters on rheumatology — on osteoporosis, osteoarthritis, rheumatoid arthritis, and lupus — are excellent, but they barely mention fibromyalgia and say nothing about sprains, strains, backache, and other common problems.

The chapter on mitral-valve prolapse, rather than provide a “fascinating panoramic vista of common but vague complaints,” makes the reader impatient with its description of this syndrome as a dumping ground of female complaints and unsure what relation these complaints and their treatment have to mitral-valve prolapse.

There are omissions of descriptions of common infections but good sections on patients at risk for sexually transmitted diseases and on sinusitis and rhinitis. The chapters on hypertension, angina, heart failure, and inflammatory bowel disease are excellent but give no information on heartburn or other common upper gastrointestinal problems.

There are very good chapters on headache and chronic fatigue and their management, and an excellent section on common psychiatric problems: premenstrual syndrome, alcohol and drug problems, eating and sleeping disorders, personality and anxiety disorders; but some chapters have fewer suggestions for managing these disorders than are needed for primary care providers. Since this is a textbook for obstetrician–gynecologists, it has no information on reproductive health care, including breast disease; there is nothing on immunizations or age-appropriate services. Even so, this book provides useful information about individual diseases and common problems that patients have.

Luella Klein, M.D.
Emory University School of Medicine, Atlanta, GA 30303