Book Review

Practical Strategies in Pediatric Diagnosis and Therapy

N Engl J Med 1997; 336:1921-1922June 26, 1997

Article

Practical Strategies in Pediatric Diagnosis and Therapy
Edited by Robert M. Kliegman, with Michael L. Nieder and Dennis M. Super. 1097 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $75. ISBN: 0-7216-5161-5

Toward the goal of achieving what they call “the ultimate synthesis of the facts about the patient's situation with the clinician's practical experience and knowledge of the literature,” Robert Kliegman and his associates have produced a textbook that is true to its title, Practical Strategies in Pediatric Diagnosis and Therapy. This book uses the physician's knowledge of the history, physical examination, and laboratory findings as a guide to the management of common illnesses in children.

To lay the foundation for subsequent chapters on diagnosis and management, the first section focuses on principles. The contributors discuss clinical decision making, the application of the medical literature to decision making, and the choice of optimal therapies from a range of possibilities, using actual cases to reinforce statistical approaches. This section has two chapters on cultural beliefs and behavior and ethical principles in clinical decision making. Without being patronizing, the authors of these chapters speak to the issues of diversity in thought and experience in clinical medicine. This first section establishes a solid basis for the scientific and humanistic principles of pediatric practice.

The second section uses the organ-system approach to common presenting symptoms in children. Most of the chapters include a summary of the relevant physiologic and pathophysiologic information, important considerations and questions to ask when obtaining a history, and pertinent factors in the physical examination.

There are comprehensive lists for differential diagnosis and excellent reviews of laboratory tests and radiographic investigations. Recommendations for treatment and management are based on the natural history of the disorder and untoward sequelae. Each chapter contains references ranging from classic studies to papers published as recently as 1995. Many chapters have excellent photographs, although they are all black and white.

Carl Erwin Johnson, M.D.
University of California, San Francisco, San Francisco, CA 94115