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Oxford Handbook of Clinical Specialties

Article in BJA British Journal of Anaesthesia · October 2013

DOI: 10.1093/bja/aet361

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BJA
Despite its stated objective of appealing to junior trainees
(residents), I believe this book should not be used as an intro-
duction to anaesthesia. Rather, it should be used to embellish
the basic knowledge that is necessary for clinical decision-
making in senior trainees preparing for Final Fellowship or
equivalent level exams. It will certainly be a strong support to
practising clinicians, who constantly need to keep up-to-date
with the plethora of available data in the literature. More
than that though, the clinician aspiring to maintain quality
CEPD should find that this textbook enriches a reflective prac-
tice by not only bringing together the best relevant knowledge,
but does so in a manner which acknowledges the conflicts and
balances of individual risk –benefit assessment which are the
bedrock of effective clinical practice.
D. J. Buggy
Dublin, Ireland
E-mail: donal.buggy@ucd.ie
doi:10.1093/bja/aet357
Oxford Handbook of Clinical Specialties, 9th Edn. J. Collier,
M. Longmore and K. Amarakone (editors). Published by
Oxford University Press. Pp. 842. Price £30.00. ISBN 978-0-19-
959118-3.
As a fourth-year medical student, I have had the eighth edition
of the Oxford Handbook of Clinical Specialties (OHCS) for around
2 yr now: it is battered, bruised, bits of the plastic are peeling
off, and most of the Orthopaedics section has fallen out. You
may take this as an example of how much use I have derived
from it, rather than a commentary on durability.
The Oxford Handbook of Clinical Medicine (OHCM) has long
been an essential guide for medical students and junior
doctors alike, and I imagine you would be hard pressed to
find a GP surgery or hospital ward without at least one copy
of it, often badly worn, inevitably not the most recent edition,
but still referenced daily by the throngs of juniors and students.
The first edition of the Oxford Handbook of Clinical Specialties
was published only two years later than the OHCM, but
somehow never attained the same ubiquity.
The ninth edition contains the same eclectic mix of a dozen
chapters as the previous edition, covering 11 medical and sur-
gical specialities and a chapter on eponymous syndromes. At
first glance, this may appear to have been assembled at
random, but on closer inspection, the chapters actually com-
plement each other flawlessly.
The layout of the ninth edition is broadly similar to the
eighth, although it is now more flamboyantly coloured, blue
or red adorning every page margin as opposed to lilac and
pink. The same vibrancy of colour is applied to the 400 or so
images adorning so many of the pages, which makes the
book more attractive, yes, but also serves to make the multifoli-
ate radiographs, CT slices, MRIs, and photographs easier to see.
Unlike the eighth edition, I never felt I had to hold this edition
two inches from my face to see what was (apparently)
852
Book reviews
abnormal on a radiograph. The benefit of the higher quality
printing is most apparent in the dermatology and opthalmol-
ogy sections.
More prominent, in the top left of most pages, is a system of
crosses, indicating the author’s perceived importance of a
topic. The system ranges from 0 to 3, with three representing
key topics within a field. It is designed so that first-time
readers can prioritize their reading of a handbook that contains
more than 800 pages. This allows the reader to get a basic over-
view of a speciality more rapidly by allowing them to focus on
the most important topics during the first time of reading
and this generally works well.
As one would expect, the content of the ninth edition has
been updated to include new evidence, changes in practice,
and recent NICE guidelines. Each page contains an overview
of a condition, that is concise and to the point, which is supple-
mented by footnotes, boxes containing extra information,
flow charts, and illustrations. Inevitably in certain sub-
jects—especially the paediatrics, obstetrics, and gynaecology
sections—the aspiring student requires more depth for their
clinical attachments than the OHCS could hope to provide, but
as a quick reference tool, it is infallible. The amount of overlap
between some of the specialties is significant. For example, I
gained a better appreciation of the multidisciplinary issues of
Labour Ward case management by the fact I had a reference
workon obstetric and gynaecological conditions, with paediatric
and anaesthetic management strategies discussed alongside.
The anaesthesia section contains a brief but comprehen-
sive overview of the practical conduct of anaesthesia. Al-
though I personally found it somewhat lacking in detail
regarding the pharmacology of the drugs anaesthetists use
daily, it still goes a long way towards providing an overview
of the speciality, which is sorely lacking in most textbooks
relevant to a medical student. Pre- and postoperative prepar-
ation for surgery is also covered with a useful discussion of the
risks of anaesthesia.
The Primary Care section is altogether different from the
others, containing little in the way of hard clinical facts, but a
lot of practical information with sections covering everything
from performance monitoring to smoking cessation.
Unusually for a textbook, there is self-professed ‘unique
philosophy’ running throughout it, outlined in the preface. It
attempts to highlight examples of good ethics, through discus-
sion and anecdotes from the authors interspaced through the
more objective pages.
The ninth edition is an incremental advancement over the
previous version. The updated information, improved layout,
and better quality of illustration are all improvements one
would expect. The content remains of the same high quality,
and the holistic philosophy of the authors is interesting to
read. However, if you already own the eighth edition, there
really is not much point buying this—a lot of pages are
word-for-word identical to its predecessor. Students starting
the clinical phase of their course will be the primary target audi-
ence, but this textbook would also be of value as a reference
tool for anaesthetists, to allow an appreciation of the how
surgery fits into the management of conditions that they
Book reviews
may not have been encountered since their own time at
medical school.
J. Hayes
M. Wiles*
Sheffield, UK
*E-mail: matthew.wiles@sth.nhs.uk
doi:10.1093/bja/aet361
Expert Decision Making on Opioid Treatment. J. C. Ballantyne
and D. J. Tauben (editors). Published by Oxford University
Press. Pp. 145. Price £30.00. ISBN 978-0-19-976888-2.
Opioid prescribing for chronic pain continues to increase, despite
the paucity of evidence in support. Indeed, the weight of evi-
dence indicates that opioids prescribed for chronic non-cancer
pain reduce function and prolong pain and disability. Yet, pain
physicians agree that some patients do benefit, so how do we
decide who to trial with strong opioids?
This small book makes an admirable attempt to answer this
difficult question. It is another in the Oxford University Press
series on Pain Management and follows the compact format
of its predecessors. The editors and most of the authors are
from the USA, but this does not detract from its relevance to
a UK reader.
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BJA
The book consists of 12 short chapters and describes the use
of opioids in different clinical scenarios, for example, pain after
trauma, and pain associated with chronic debilitating disease.
There is a chapter on opioids in cancer pain and chapters dis-
cussing complex problems associated with opioid prescribing
such as a history of substance misuse and pain without a
pathoanatomic diagnosis. Each chapter begins with a case
history and this makes for a very readable format. The cases
are well chosen and cover many of the problems that we see
in the pain clinic, so the relevance is applicable beyond the
case described.
There is a useful chapter on tools to improve management
such as questionnaires to measure pain, function, and disabil-
ity and risk from opioids.
The book concludes with a very helpful chapter from one of
the editors entitled ‘Not a suitable candidate, saying no’.
This is a useful book with a wealth of guidance for doctors
dealing with a difficult patient group. It is suitable for doctors
working in pain clinics and physicians in primary and secondary
care who prescribe strong opioids for chronic pain.
R. Atcheson
Sheffield, UK
E-mail: robert.atcheson@sth.nhs.uk
doi:10.1093/bja/aet362
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