Book Review

Emergency Medicine: Concepts and clinical practice

N Engl J Med 1998; 338:1929June 25, 1998

Article

Emergency Medicine: Concepts and clinical practice
Fourth edition. Edited by Peter Rosen and Roger Barkin, with 7 others. 2930 pp. in three volumes, illustrated. St. Louis, Mosby, 1998. $239. ISBN: 0-8151-3774-5

Emergency Medicine: Concepts and Clinical Practice has gained the reputation of being the standard reference textbook for the young specialty of emergency medicine. The 1998 fourth edition offers an extensive treatment of emergency medicine, with several new chapters, including ones on clinical decision making, youth and gang violence, clinical forensics, and occupational health in the emergency department. The three volumes have grown to weigh 21 pounds with 2930 pages. This new edition maintains the comprehensiveness and accessible writing style that make this work a model reference book.

The book's strengths include its scope, informal writing style, and lengthy bibliographies. It contains complete treatments of the traditional acute medical, surgical, and pediatric topics. In addition, it covers numerous issues more particular to emergency medicine, such as foreign bodies, sexual assault, and near-drowning. The writing style is relaxed and maintains a clinical focus. The editors have required that each chapter be written by a practicing emergency physician. Readers will find it easy to partake of entire chapters, whether reviewing for a presentation, studying for boards, or learning new material while in training. Each chapter is exceedingly well referenced. This book provides more citations than typical textbooks, and footnotes to these references are provided in the text. Practitioners of evidence-based medicine will find these chapter bibliographies very useful for exploring topics more in depth.

This should not be the book of choice for a moonlighting physician needing quick answers while working an occasional emergency-department shift. Though the number of physicians “dabbling” in emergency medicine is declining, such doctors should look elsewhere for an emergency-medicine handbook. This book's scope and level of detail place it in the reference category.

The book is not structured with a problem- or symptom-based approach. There is no specific chapter on chest pain or the red eye. There are very few quick-reference algorithms for analyzing presenting symptoms. Emergency Medicine leaves other books to fill the niche of the rapid-access clinical guidebook. Practitioners will find it useful during an emergency-department shift when they encounter complex or unusual problems.

The timeliness of textbook information is limited by the duration of the editing and publishing cycle. The hepatitis-prevention section of the book does not contain updated information about the lack of benefit of immune globulin for the treatment of exposure to hepatitis C, even though this was described in a 1996 report by the Centers for Disease Control and Prevention. Users of any new reference textbook must still review reports and journals to maintain their knowledge of the best medical practice.

This textbook is available in both CD-ROM and subscription Internet versions. These new formats offer rapid searching and some element of portability and wide access. However, the size of the computer screen limits the amount of text that can be displayed at one time. Also, the possibility of hardware failure mandates that the hardback version of this book be on hand in each emergency department. In addition, the book version remains easier to use and is still the preferred medium for physicians who wish to review and digest these comprehensive chapters of medical material.

The field of emergency medicine has enjoyed great popularity recently, both among television viewers and medical students seeking residency training. Emergency Medicine: Concepts and Clinical Practice is an essential textbook for all physicians who are learning or practicing this specialty.

Joel Buchanan, M.D.
University of Wisconsin Medical School, Madison, WI 53792