Far beyond being a text describing how to perform a history and physical exam, DeGowin's Diagnostic Examination is, uniquely, a text to assist clinicians in thinking about symptoms and physical signs to facilitate generation of reasonable, testable diagnostic hypotheses. The clinician's goal in performing a history and physical examination is to generate these diagnostic hypotheses. This was true for Hippocrates and Osler and remains true today. The practice of medicine would be simple if each symptomor sign indicated a single disease. There are enormous numbers of symptoms and signs (we cover several hundred) and they can occur in a nearly infinite number of combinations and temporal patterns. These symptoms and signs are the rough fibers from which the clinician must weave a clinical narrative, anatomically and pathophysiologically explicit, forming the diagnostic hypotheses. To master the diagnostic process, a clinician must have four essential attributes:
- 1. Knowledge: Familiarity with the pathophysiology, symptoms, and signs of common and unusual diseases.
- 2. Skill: The ability to take an accurate and complete history and perform an appropriate physical examination to elicit the pattern of symptoms and signs from each patient.
- 3. Experience: Comprehensive experience with many diseases and patients, each thoroughly evaluated, allows the skilled clinician to generate a probabilistic differential diagnosis, a list of those diseases or conditions most likely to be causes of this patient's illness.
- 4. Judgment: Knowledge of medical science and the medical literature combined with experience reflected upon hones the judgment necessary to know when and how to test these hypotheses with appropriate laboratory tests or clinical interventions [Reilly BM. Physical examination in the care of medical inpatients: an observational study. Lancet. 2003;362:1100–1105].
DeGowin's Diagnostic Examination has been used by students and clinicians for over 40 years precisely because of its usefulness in this diagnostic process:
- It describes the techniques for obtaining a complete history and performing a thorough physical examination.
- It links symptoms and signs with the pathophysiology of disease.
- It presents an approach to differential diagnosis, based upon the pathophysiology of disease, which can be efficiently tested in the laboratory.
- It does all of this in a format that can be used as a quick reference at the “point of care” and as a text to study the principles and practice of history taking and physical examination.
In undertaking this ninth edition of a venerable classic, my goal is once again to preserve the unique strengths of previous editions, while adding recent information and references, reducing redundancy and improving clarity. The second edition is one of the few books I have retained from medical school, 35 years ago. The reason is that DeGowin's Diagnostic Examination emphasizes the unchanging aspects of clinical medicine—the symptoms and signs of disease as related by the patient and discovered by physical examination.
Pathophysiology links the patient's story of their illness (the history), the physical signs of disease, and the changes in biologic structure and function revealed by imaging studies and laboratory testing. Patients describe symptoms, we need to hear pathophysiology; we observe signs, we need to see pathophysiology; the radiologist and laboratories report findings, we need to think pathophysiology. Understanding pathophysiology gives us the tools to understand disease as alterations in normal physiology and anatomy and illness as the patient's experience of these changes.
A discussion of pathophysiology (highlighted in blue) occurs after many subject headings. The discussions are brief and included when they assist understanding the symptom or sign. Readers are encouraged to consult physiology texts to have a full understanding of normal and abnormal physiology [Guyton AC, Hall JE. Textbook of Medical Physiology. 10th ed. Philadelphia: W.B. Saunders Company: 2000. Lingappa VR, Farey K. Physiological Medicine: A Clinical Approach to Basic Medical Physiology. New York, NY: McGraw-Hill; 2000]. In addition, each chapter discusses common syndromes associated with that body region, to provide you with a sense of the common and uncommon but serious disease patterns.
DeGowin's Diagnostic Examination is organized as a useful bedside guide to assist diagnosis. Part I introduces the conceptual framework for the diagnostic process in Chapter 1, the essentials of history taking and documentation in Chapter 2, and the screening physical examination in Chapter 3. Part I and Chapter 17, which introduces the principles of diagnostic testing, should be read and understood by every clinician.
Part II, Chapters 4 through 14, forms the body of the book. Two introductory chapters discuss the vital signs (Chapter 4) and major physiologic systems that do not have a primary representation in a single body region (Chapter 5). Chapters 6 to 14 are organized around the body regions sequentially examined during the physical examination and each has a common structure outlined in the Introduction and User's Guide. To avoid duplication, the text is heavily cross-referenced. I hope the reader will find this useful and not too cumbersome.
References to articles from the medical literature are included in the body of the text. We have chosen articles that provide useful diagnostic information including excellent descriptions of diseases and syndromes, thoughtful discussions of the approach to differential diagnosis and evaluation of common and unusual clinical problems, and, in some cases, photographs illustrating key findings. Most references are fromthe major general medical journals, the New England Journal of Medicine, the Lancet, the Annals of Internal Medicine, and the Journal of the American Medical Association. This implies that a clinician who regularly studies these journals will keep abreast of the broad field of medical diagnosis. Some references are dated in their recommendations for laboratory testing and treatment; they are included because they give thorough descriptions of the relevant clinical syndromes, often with excellent discussions of the approach to differential diagnosis. Tests and treatments come and go, but good thinking has staying power. The reader must always check current resources before initiating a laboratory evaluation or therapeutic program.
Evidence-based articles on the utility of the physical exam are included, mostly from the Rational Clinical Examination series published over the last 15 years in the Journal of the American Medical Association. They are included with the caveat that they evaluate the physical exam as a hypothesis-testing tool, not as a hypothesis generating task; their emphasis on transforming the qualitative hypothesis generating task of the history and physical examination into a quantitative hypothesis testing task is misguided [Feinstein AR. Clinical Judgement revisited: the distraction of quantitative models. Ann Intern Med. 1994;120:799–805].
Each chapter was independently reviewed by faculty members of the University of Iowa Roy J. and Lucille A. Carver College of Medicine. Their feedback and assistance is gratefully acknowledged. Reviewers for this edition are Hillary Beaver MD, Associate Professor Clinical Ophthalmology (Chapter 7); Jane Engeldinger, MD, Professor, Clinical Obstetrics and Gynecology (Chapters 10 and 11); John Lee, MD, Assistant Professor, Department of Otolaryngology (Chapter 7); Christopher J. Goerdt, MD, MPH, Associate Professor, Clinical Internal Medicine, Division of General Internal Medicine (Chapters 1–3, 16, and 17); Vicki Kijewski, MD, Assistant Professor of Clinical Psychiatry and Internal Medicine (Chapter 15); Victoria Jean Allen Sharp, MD, MBA, Clinical Associate Professor, Departments of Urology and Family Medicine (Chapters 10 and 12); William B. Silverman, MD, Professor, Clinical Internal Medicine, Division of Gastroenterology and Hepatobiliary Diseases (Chapter 9); Haraldine A. Stafford, MD, PhD, Associate Professor, Clinical Internal Medicine, Division of Rheumatology (Chapter 13); Marta Vanbeek, MD, MPH, Clinical Assistant Professor, Department of Dermatology (Chapter 6); and Michael Wall, MD, Professor of Neurology and Ophthalmology (Chapters 7 and 14).
Key Features
- Top-to-bottom coverage of differential diagnosis, organized by systems, signs, and syndromes.
- High-yield overviews of each organ/region/system, followed by the definition of key presenting signs and their possible origins.
- NEW! Updated content includes the latest developments in evidence-based physical examination, along with references to the popular JAMA series “The Rational Clinical Examination”.
- NEW! 24 full-color illustrations.
- NEW! Full-text download for your mobile device.
Contents
Part 1. The Diagnostic Framework
- Chapter 1 Diagnosis
- Chapter 2 History Taking and the Medical Record
- Chapter 3 The Screening Physical Examination
- Video: The Screening Physical Examination
Part 2. The Diagnostic Examination
- Chapter 4 Vital Signs, Anthropometric Data, and Pain
- Chapter 5 Non-Regional Systems and Diseases
- Video: Examination of the Lymph Nodes Part 1
- Chapter 6 The Skin and Nails
- Video: Examination of the Skin and Nails
- Chapter 7 The Head and Neck
- Video: Examination of the Head and Neck Part 1
- Video: Examination of the Head and Neck Part 2
- Chapter 8 The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts
- Chapter 9 The Abdomen, Perineum, Anus, and Rectosigmoid
- Chapter 10 The Urinary System
- Chapter 11 The Female Genitalia and Reproductive System
- Chapter 12 The Male Genitalia and Reproductive System
- Chapter 13 The Spine, Pelvis and Extremities
- Chapter 14 The Neurologic Examination
- Chapter 15 The Mental Status, Psychiatric, and Social Evaluations
Part 3 Preoperative Evaluation
- Chapter 16 The Preoperative Evaluation
Part 4 Use of the Laboratory and Diagnostic Imaging
- Chapter 17 Principles of Diagnostic Testing
- Chapter 18 Common Laboratory Tests
Book Details
- Paperback: 944 pages
- Publisher: McGraw-Hill Professional; 9 edition
- Language: English
- ISBN-10: 0071478981
- ISBN-13: 978-0071478984
- Product Dimensions: 8.4 x 5.1 x 1.3 inches
List Price: $48.95