RRP: AU$119.95

Snell, RS. Clinical Neuroanatomy, Seventh Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: AU$107.80

As stated by Sparks and colleagues [1] in their comparison of Clinically Oriented Anatomy and Gray’s Anatomy for Students, studying anatomy can be a challenging endeavour. This is true even more so for the study of neuroanatomy, which many students find particularly overwhelming. In the neuroanatomy textbook arena stand two ‘gold standard’ textbooks: Neuroanatomy through Clinical Cases, by Hal Blumenfeld, and Clinical Neuroanatomy, by Richard Snell. Inspired by the aforementioned comparative anatomy textbook review in the previous issue of the journal, I ponder the question: Which neuroanatomy textbook is superior, the more established Snell or the newer Blumenfeld?

I begin my comparison with a consideration of their similarities…

Solomon L, Warwick D, Nayagam S. Apley’s Concise System of Orthopaedics and Fractures. 3rd ed. London (UK): Hodder Arnold; 2005.

RRP AU$52.65

The 2006-2007 Australian Hospital Statistics demonstrated that fractures alone accounted for 173,410 separations from Australian Hospitals. [1] As such, all interns will see a potential orthopaedic patient at least once in their Emergency rotation and will require a sound knowledge of orthopaedics. Like all medical fields, knowledge is gathered from clinical rotations, doctors and peers. However, this learning will need to be supplemented with textbook study. One of the most popular medical student level textbooks for orthopaedics is Apley’s Concise System of Orthopaedics and Fractures. Currently in its third edition, Apley’s provides 390 pages of musculoskeletal medicine ranging from the classification and management of basic fractures to more obscure genetic conditions such as brittle bone disease.

Apley’s is separated into three general categories: General orthopaedics, Regional orthopaedics and Fractures and joint injuries. Each Orthopaedic condition is explained in the time-honoured method of history, examination findings, imaging and investigation findings, and management. This provides medical students with a well-structured and concise guide to the signs and symptoms of each specific condition. Furthermore, for some of the more common musculoskeletal conditions, such as osteoarthritis, considerable time has been donated to the pathophysiology and both the operative and non-operative treatment options.

One of the criticisms of this text is that there is information on some of the more obscure genetic orthopaedic conditions, unlikely to be useful in the acute setting. The section on fractures is detailed and provides information on the different types of fractures possible for every bone. For the average medical student on a standard orthopaedic rotation, it is unlikely that they will remember all of the specifics of each fracture type and eponyms, let alone their management. Further, Apley’s provides minimal therapeutic drug classification and doses for the management of some of the medically treated orthopaedic conditions.

A sufficient grounding in orthopaedics is essential for any intern. A significant proportion of this textbook is dedicated to fracture diagnosis and management, invaluable for the Emergency Department setting where acute traumatic injuries are more commonly treated, rather than progressive chronic conditions. Apley’s Concise System of Orthopaedics and Fractures provides an easy-to-read textbook for students wishing to learn the basics of the diagnosis and management of common orthopaedic conditions.

Conflicts of Interest

None declared.

References

[1] Australian Institute of Health and Welfare. Australian Hospital Statistics 2006-2007 [Internet]. Canberra: Australian Government; 2008 [updated 2008 May; cited 2010 July 10]. Available from:URL: http://www.aihw.gov.au/publications/hse/ahs06-07/ahs06-07.pdf

Breen KJ, Cordner SM, Thomson CJH, Plueckhahn VD. Good Medical Practice: Professionalism, Ethics and Law. Port Melbourne: Cambridge University Press; 2010.

RRP: $75.00

Anyone brave enough to write a textbook about Australian law quickly runs into an almost insurmountable obstacle: federalism. In effect, Australia has nine jurisdictions. The number of activities that are illegal in one jurisdiction (usually Queensland) whilst positively encouraged in another (usually the ACT) is myriad. Producing a textbook for a national audience that covers these jurisdictional variations comprehensively without boring the reader senseless is a challenge.

Not satisfied with simply exploring the complexities of the Australian legal system as it affects medical practice, however, the authors of Good Medical Practice: Professionalism, Ethics and Law decided to examine ethics and professionalism as well. Drawing together these three systems that govern appropriate conduct was surely a Herculean task, but it has resulted in a thoroughly readable and useful book.

The authors’ decision to combine ethical, legal and professional principles has allowed them to distil key concepts and provide comprehensive, practical guidance without overwhelming the reader. For example, a chapter on the complex legislative regimes surrounding the issue of privacy could usually be expected to leave the reader confused, or possibly even sobbing. Here, the heavy legal content of the chapter is rendered almost redundant by the authors’ perceptive preface that doctors who adhere to ethical principles of preserving patient confidentiality are unlikely to fall foul of privacy law. If you choose to stop reading after that point is made, you probably already know enough to avoid a major problem.

This “all-in-one” approach acknowledges the interaction between law, ethics and being a good doctor. It is the key to the success of this book. Complex legal and ethical ideas are conveyed succinctly, within the framework of practical advice on how to conduct oneself professionally. The authors’ tips on preventing unfortunate outcomes – such as formal complaints, lawsuits or drug-fuelled meltdowns – are sensible and worth reading even if you skip just about everything else.

First-year medical students and international graduates will find the chapter explaining the ins and outs of Australia’s health system valuable; a chapter on the professional responsibilities and regulation of other health care workers is also useful for those experiencing their first exposure to multi-disciplinary teams. Chapters covering issues relevant to clinical research, prescribing, entering practice, and the ethical allocation of health care resources are likely to be useful to later-year students and junior doctors.

There are a few problems with the text, however. For example the chapter on the Australian legal system appears towards the end of the book. I’d suggest reading it first, to avoid confusion when legal terms are encountered. In addition, unfortunate timing has meant that the chapter on the regulation of the profession does not address the new regime of national registration, but the general principles it outlines are still relevant.

Overall, the book is well-structured, easy to use, and succinct without sacrificing clarity. For those who would like more information, there are some good resources suggested at the end of each chapter. For the most part, however, it will be unnecessary to consult an additional text if one requires simply a good working knowledge of relevant ethical and legal principles.

It is perhaps disappointing that a book exploring ethical concepts is not more thought-provoking (in this line, I’d recommend Annas’ excellent, if somewhat dated, book [1]), but it seems that the authors have elected to guide rather than challenge their readers. In this they have been successful.

In short, Good Medical Practice delivers exactly what its title promises: succinct information about the ethical and legal responsibilities of medical practitioners (and students) within a broader professional context. The intended audience of medical students and junior doctors is likely to benefit from some time spent reading this book.

Conflicts of Interest

None declared.

Reference

[1] Annas GJ. Standard of Care: The Law of American Bioethics. New York: Oxford University Press; 1997.

Technology is always presenting us with new ways of going about our daily lives, and our inability to be separated from our mobile phone, internet or online social networking is growing. Some technology has become obsolete and fallen into obscurity, while some has never caught on. One that definitely has, though, is Apple’s iPhone. As medical students, smartphones have the potential to revolutionise our education and training, and one heavy contributor to this is Apple’s growing library of medical ‘apps’ (applications made specifically for iPhones).

‘Medical’ is a headline category on the iPhone App Store, right next to Utilities, Lifestyle and Games. It is even separate from Healthcare and Fitness – something a good chain bookstore is yet to figure out. Entering this category brings up a multitude of free and paid apps that will be of interest to practicing physicians, medical students or other health care professionals. Finding an app to suit one’s needs is made even easier by using one of several online app directories. Apps can do everything from looking up reference values, differentiating between types of arrhythmias to performing useful calculations. While this article cannot hope to delve very far into the thousands of medical apps available, what follows is an overview of some of the most popular ones, which may prove useful for the uninitiated.

The app ABG, or Arterial Blood Gas, can help in the sometimes complicated world of blood gases; simply type in lab values to determine if an acidosis is respiratory or metabolic in nature. Instant ECG (electrocardiogram) displays rhythm strips of many common arrhythmias to study and then provides a quiz to consolidate learning. General Medical History categorically runs through all the questions one should ask to take a medical history. It is very comprehensive, and could be particularly useful for junior medical students who are still becoming familiar with the basics of history-taking. However, pulling out an iPhone in front of a patient, let alone a clinical supervisor, will no doubt fail to convey the best impression.

Some of the big names in textbooks have already made their way to the iPhone platform. The Netter’s series of texts is available, including very handy anatomy flashcards. These are an ideal way to brush up on anatomical identification skills while commuting or waiting around. However, some may find that the size of the screen does not do justice to Netter’s famous illustrations. The Merck Manual of Diagnosis and Therapy is a guide on the essentials of diagnosis and treatment. Taber’s Medical Dictionary is perfect for a mental block on what Klippel-Trenaunay-Weber Syndrome actually is. The original Gray’s Anatomy is right amongst the lineup in all its pencil-rendered beauty. However, while it does have a search function, it does not have a table of contents, which is a major oversight. Medscape, Epocrates and Skyscape are bundled apps which include medical calculators and continually updated drug and clinical references – a veritable all-in-one reference for clinicians on the go. Epocrates even has a drug identification tool to allow you to identify a patient’s pills.

The Australian-specific content is also increasing. Frank Shann’s Drug Doses promises to end the suffering of those who need a little reminder just how many mg/kg of fentanyl to give a child. Likewise, MIMS Australia now has their product available for the platform, allowing healthcare professionals to look up entire product information. Most of the calculator programs such as MedCalc have the ability to change units, allowing the user to easily modify the program to suit the needs of an Australian medico.

One of the drawbacks is that some apps are just not in an affordable price range for many students (Table 1). Netter’s Anatomy Flashcards is priced at $47.99, MIMS is an explosive $170, and some, such as Frank Shann’s Drug Doses at $23.99, are over double the price of the hardcopy version. However, some of the helpful ones are free, such as Medscape and Skyscape, and there are always useful medical apps on sale. Epocrates has several tiers of its product. The basic version is free, and includes features such as a drug interaction checker and pill identifier. However, to obtain features such as disease images and a medical dictionary, a subscription is required, ranging from US$99 to US$199 depending on the features required.

Another major drawback to some of these apps is that they consume considerable amounts of storage space, such as Gray’s Anatomy at 402…

As medical students progress through their clinical years, they are exposed to the varied streams of medicine, which not only functions as a key component in their broader medical training, but serves as a degustation for potential specialities they may choose to pursue after medical school. Students often find themselves starting a specialty term without knowing what they need to know, let alone which is the best student-friendly textbook.

The study of anatomy is often a challenging endeavour for many medical students. Central to the learning process is the use of a good textbook. Two of the most often recommended texts for medical students are Gray’s Anatomy for Students (GAS), descended from the iconic text by Henry Gray, and Clinically Oriented Anatomy (COA), by Moore, Dalley and Agur.

Both texts employ a regional approach to the study of anatomy. GAS separates each chapter into four sections: Conceptual Overview, Regional Anatomy, Surface Anatomy and Clinical Cases. The conceptual overview aims to provide the very basic concepts of each region in a concise summary before moving on to an increasingly detailed description. While this approach may be useful for the beginner or reviewer, the inevitable repetition creates a degree of redundancy. COA presents information in a ‘bones up’ format, progressively adding surrounding structures before detailing the arthrology of each region. Each chapter concludes with a series of radiographic images to complement integration and understanding.

Certain striking distinctions are evident in the textual quality of each book. GAS aims to strip away irrelevant information into an easy-to-read summation while leaving intricate details for other texts. While this provides an excellent introduction for the neophyte, COA includes more rigorous explanations concerning the finer points and the complex interaction with surrounding structures. An enlightening example of the differing styles can be observed through the treatment attributed to the sternocleidomastoid (SCM) muscle. A concise, tabular description of muscular attachments, innervations and basic function is provided in GAS in association with a stylised diagram indicating its position in the neck. Conversely, COA devotes an entire four page sub-section to a detailed discussion of the manner in which body position and the use of synergist muscle groups can alter function of the SCM beyond an isolated view of the muscle acting independently in the anatomical position. Thus, while simplified to enhance the initial integration of basic concepts, GAS may simultaneously perpetuate certain erroneous notions concerning the nature of anatomical function. On the other hand, the text in COA may reduce its effectiveness for the uninitiated, while GAS may prove to be too simplistic for the interested student.

Both books approach diagrammatical representation through the use of computer-generated imagery, though distinct dissimilarities are visible. COA depicts each region by incorporating detailed and realistic diagrams which are thoroughly labelled. In contrast, GAS represents analogous images through a distinctly stylised fashion. Major structures are portrayed in an idealistic mode, which, in combination with relatively sparse labelling, may impede practical application, particularly in medical courses focussed on anatomical dissections. However the simplified overview, devoid of extensive detail, is potentially easier to comprehend for the less experienced anatomist. In addition to detailed, accurate labels, COA consolidates diagrammatic elements through representations in various anatomical planes. The depiction of distinct layers within each system aids the appreciation of the detailed nature of such structures. Ultimately, COA associates these illustrative characteristics through the use of numerous, detailed figures within each specified anatomical region. The use of COA may prove to be beneficial, both in dissection and in providing a broader scope of understanding.

The integration of clinical aspects throughout a text is essential to the effective understanding of anatomical information. Both books appear to have achieved a relatively streamlined integration of such information through the utilisation of clinical vignettes. Complemented with relevant diagrams, topics covered in the text of these vignettes include information relating to development, anatomical variation, radiology and pathology. For those without significant exposure to anatomy, having clinical information presented in such a fashion is an ideal mode for the consolidation of vital concepts. The use of end of chapter case studies in GAS allows the reader to evaluate their own level of understanding, a feature that is absent in COA. Radiological correlations in GAS are discussed further through an in-text approach. Alternatively, COA utilises radiological imaging juxtaposed with easily understood computer generated diagrams, allowing the student to…

Drake R, Vogl W, Mitchell A. Gray’s Anatomy for Students. London: Churchill Livingstone; 2009.

RRP: $138.00

Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy, Sixth Edition. Baltimore: Lippincott Williams & Wilkins; 2009.

RRP: $129.80