Book Review

Textbook of Primary Care Medicine

N Engl J Med 1997; 336:1110April 10, 1997

Article

Textbook of Primary Care Medicine
Second edition. Edited by John Noble, with Harry L. Greene, II, Geoffrey A. Modest, Wendy Levinson, and Mark J. Young. 1952 pp., illustrated. St. Louis, Mosby, 1995. $99.95. ISBN: 0-8016-7841-2

The Textbook of Primary Care Medicine is the second edition of The Textbook of General Medicine and Primary Care, which was published in 1987 by Little, Brown (Boston). John Noble is editor-in-chief of both editions, and his experience and that of his senior editors make this book very readable and usable. This new edition is more concise than the first edition, with 15 sections on systemic diseases encountered in primary care; the first edition had 24 sections and over 400 more pages. Although the earlier edition had separate sections on psychiatric illness, alcoholism, and substance abuse, this edition covers these topics in one section on psychosocial and behavioral issues. In addition, this section includes discussions of common family problems, behavioral change (e.g., cessation of smoking), domestic violence, death and dying, and primary care of the gay man. The section on obstetrics and gynecology in the earlier edition has been replaced in the new edition by an updated, more comprehensive section entitled “Women's Health.”

In 1966 the Millis Commission introduced the concept of the primary physician, which led to the term “primary care physician.” According to the Millis report, the primary care physician was one who provided first-contact care for undifferentiated patients; comprehensive care for more than 90 percent of a patient's medical care needs; continuity of care over time and in a variety of circumstances; and coordination of the patient's care within the health care system, including referrals to appropriate specialists. The Textbook of Primary Care Medicine addresses the needs of such a physician. It is outstanding in its use of charts and graphs to present the essential points in the clinical manifestations and management of the illnesses and problems seen in primary care practice. Perhaps the most outstanding innovation in the book is the inclusion of managed-care guides and algorithms. The guides include information on the patient's presentation, base-line information, recommended laboratory tests, approximate duration of care, frequency of follow-up, and indications for referral. There are algorithms for the management of problems such as hypertension, syncope, unstable angina, and various forms of arthritis. These guides and algorithms are major contributions to primary care medicine as it is practiced today.

The content of the book is largely current and has been updated where appropriate. The chapter by John Graham on the presentation and management of headaches is virtually unchanged, which is consistent with the state of the art in this area. On the other hand, the section on infectious diseases reflects the emergence of new infectious-disease agents, such as the human immunodeficiency virus, the hantavirus, and Helicobacter pylori, which is a major cause of gastritis and peptic ulcer disease. The reemergence of older diseases, such as malaria and tuberculosis, is also dealt with comprehensively.

However, the section on infectious diseases also has some problems. Although there is an extensive discussion of old and new antimicrobial agents, there is very little discussion of the nature of the evolution of resistance to antimicrobial agents or the critical role of primary care physicians in combating this trend. Likewise, the need for the involvement of primary care physicians in disease surveillance and reporting and counseling of patients in health promotion and risk reduction is inadequately addressed.

Despite these areas of concern, this book is a major contribution to primary care practice.

David Satcher, M.D., Ph.D.
Centers for Disease Control and Prevention, Atlanta, GA 30333