Book Review

Primary Care in Gynecology

N Engl J Med 1996; 335:1928-1929December 19, 1996

Article

Primary Care in Gynecology
Edited by Frank W. Ling, Douglas W. Laube, Thomas E. Nolan, Roger P. Smith, and Thomas G. Stovall. 506 pp. Baltimore, Williams and Wilkins, 1996. $75. ISBN: 0-683-05057-5

For years, gynecologists have been the sole providers of health care for many women, especially those of reproductive age. Often office visits have focused on contraceptive issues, breast and pelvic examinations, and Pap smears. With the arrival of managed care and increasing concern about the cost of health care, gynecologists have perceived that they must provide more primary care services. This realization has stimulated a multitude of courses and articles to supplement the primary care knowledge of gynecologists. Now Ling and colleagues have brought together a talented group of clinicians to create a primary care textbook intended for practicing gynecologists.

The book has three sections: prevention, common symptoms, and common conditions. The symptoms are those that we have heard from our patients many times. The book summarizes possible causes, basic questions to ask during history-taking, and guidelines for a targeted physical examination. It also provides guidance about laboratory evaluation and treatment. In general, the authors give comprehensive lists of alternative therapeutic drugs. These extensive lists detract somewhat from the value of the book, since no guidance is given in the selection of these agents. For example, the chapter on headache lists 12 medications for the prevention of migraine. Although thorough, this approach provides limited advice for clinicians who are not experienced in the field.

Most of the chapters answer critical questions for a gynecologist: Can I be sure that I will recognize an important problem? What are the appropriate steps in the evaluation of symptoms or identified disease conditions? When should I refer a patient to a specialist? Most sections stress efficient evaluation, recommending only tests that help to diagnose or direct care. Less important tests that might seem relevant to the uninitiated are discussed, but are not recommended without cause. For example, radiographic evaluation of monoarticular arthritis is not advised, although many practitioners request x-ray films in this setting.

Primary Care in Gynecology is generally well written and readable. An interested reader can breeze through it quickly, assimilating most of the material. Limiting the focus to gynecologic practitioners allows the authors to add information relevant only to women, including information on pregnancy, variation with menses, and other specifics not always found in more general textbooks. This strength of the book, its simple structure and usability, is also a weakness: it provides only a superficial review of selected primary care topics. It does not, nor does it intend to, provide a detailed review of a wide range of topics concerning primary care. Overall, the editors have created a valuable addition to the shelves of gynecologists.

Elizabeth J. Buechler, M.D.
Harvard Community Health Plan, Boston, MA 02215