Book Reviews Articles

Harrison’s: Friend or Foe?

Longo DL, Harrison TR. Harrison’s Principles of Internal Medicine, Eighteenth Edition. London: McGraw-Hill; 2012.

RRP: $199

So a review of this text has been done before, not of Harrison’s Principles of Internal Medicine (Harrison’s) in isolation but a comparison to William Osler’s The Principles and Practice of Medicine. [1] The latest edition of Harrison’s has been available since July 2011, and as an avid user of the online version of Harrison’s (via AccessMedicine™ through the University’s library website). The book is found in two tomes, a whopping 4012 pages in total. I have a thing for being able to physically hold a book and read it, hence not relying on the online edition, which has been previously compared to the text version, as my internet connection is very erratic and the University has a concurrent users policy. [2]

Alas it was a decision that I do regret (to some extent) as I have since found myself referring to Harrison’s to find an answer to a problem, whether it be electronically via the DVD given with the book or via fl icking through the book itself, and neglecting some other general medicine or specialised texts that I own. This speaks volumes about Harrison’s comprehensive nature, but also about my enjoyment of the text.

So what do I like about the book? It is detailed, this may speak more about myself than the text but I think that many medical students appreciate this level of detail, if only for interest rather than what is actually required. I mean, do you know of any other books with 395 chapters and another 51 chapters available electronically? I love the detailed explanations of concepts such as “Insulin biosynthesis, secretion and action”, which would normally be found in a more specialised text such as Lehninger’s Principles of Biochemistry™, and pathophysiology of common diseases such as asthma, COPD and myocardial infarction. [3]

The “yellow sections” in the chapters are a great reference for medical students and physicians alike, these are the sections on treatment of certain conditions. The diagrams are great, as are flowcharts, which explain key concepts such as development of a certain condition (for example, ischaemic stroke) or treatment or diagnostic algorithms, such as tuberculosis or HIV/AIDS. The layout of the parts, sections and chapters of the text are very logical and (if you were keen enough) could be read in order for example:

“Part 10: Disorders of the cardiovascular system, Section 1: Introduction to cardiovascular disorders, Chapter 224: Basic Biology of the Cardiovascular system, Chapter 225: Epidemiology of Cardiovascular disease … Section 2: Diagnosis of Cardiovascular disorders, Chapter 227: Physical examination of the cardiovascular system, Chapter 228: Electrocardiography … Section 3: Disorders of rhythm … Section 4: Disorders of the heart … Section 5: Vascular disease”

It is easy to see how logically the book is organised, starting from the basics of the given system or group of conditions then working through epidemiology, diagnosis and then fi nally about the conditions themselves; and given that Part 10 of the book as a whole spans pages 1797 – 2082 (yes, 285 pages) you can gather an appreciation for the detail of the text. Another great feature is the “further readings” given at the end of each chapter citing original and review publications from peer reviewed journals so (if interested) you can read some more about the topic you are interested in.

What don’t I like about the book? Having two volumes can sometimes be a little tedious when you pick up one and then find that the topic you want is in the other (although you have to remember page numbers this way, it is still preferable to having one enormous tome with a tiny typeface). The organisation of the text is a double-edged sword as it can get frustrating as when searching for a condition such as polycystic ovarian syndrome (PCOS) this will bring up entries in sections such as: menstrual disorders, biology of obesity, amenorrhoea, metabolic syndrome, hirsutism and virilisation and diabetes mellitus; yet there is no definitive section on PCOS itself as there is for a condition such as phaeochromocytoma. Sometimes you open a page, and the amount of text overwhelms you and there are no figures to break it up, which can be quite intimidating for a medical student to find one specific passage or sentence. This isn’t too large a problem in my opinion, but I have known students to be put off by books of such a nature.


[1] Hogan DB. Did Osler suff er from “paranoia antitherapeuticum baltimorensis”? A comparative content analysis of The Principles and Practice of Medicine and Harrison’s Principles of Internal Medicine, 11th edition. CMAJ. 1999 Oct;161(7):842-5.

[2] DeZee KJ, Durning S, Denton GD. effect of electronic versus print format and different reading resources on knowledge acquisition in the third-year medicine clerkship. Teach Learn Med. 2005;17(4):349-54.

[3] Powers AC. “Insulin Biosynthesis, Secretion and Action” from Harrison’s Principles of Internal Medicine. 18 ed. Longo DF, A; Kasper, D; Hauser, S; Jameson, J L; Loscalzo, J, editor. Columbus: McGraw-Hill Medical; 2011.

Book Reviews Articles

The only medical science textbook you need to buy?

Wilkins R, Cross S, Megson I, Meredith D. Oxford Handbook of Medical Sciences, Second Edition. Oxford: Oxford University Press; 2011.

RRP: $47.95

A complete guide to the medical sciences that fits in your pocket? Including anatomy? It sounds like something you’d find on the bookshop shelf between Refl exology at Your Fingertips and Sex Explained. But The Oxford Handbook of Medical Sciences (OHMS) is probably one of the few serious books that handles this enormous topic and can still be picked up with one hand. The first edition was published in 2006, and it’s been a fairly constant companion since I started graduate medicine at Sydney University. The dense but well written text often feels more conducive to medical school than authoritative textbooks – if you’re asked to explain a concept in a tutorial, the 30 second answer is better than the five minute dissertation. Compiling principles and systems also means you can flip from say anatomy to immunology without piling up your desk with resources. Unfortunately, the more I’ve used the first edition the more niggling errors I’ve come across. Granted most are just typos, but others were more frustrating. Including a colour DNA sequencing output that seems more CSI-prop than medical text, at least to someone with a molecular biology background. And errors like labelling the muscles of mastication as supplied by cranial nerve VIII are inexcusable (instead of V3 mandibular – so presumably type-setting error). So OHMS1e – a great book in serious need of a revision, but could the second edition be the last medical science book you ever buy?

The OHMS second edition was published September 2011 from $35 in online bookshops. On first impression it has not transformed into a full colour extravaganza like the latest Oxford Handbooks of Clinical Medicine/Specialties. It is 40 pages longer than the original, 962 in total, and still small enough for a big pocket. Much of the first edition worked well and it is good to see that the layout remains the same, with each topic generally covered in two pages or less, with plenty of room for annotation. The first three chapters cover the essentials: cells, molecules and biochemistry – with some good looking new figures. The ten systems-based chapters are now followed by a chapter on medicine and society. The final chapter – techniques of medical sciences – has had a timely rewrite, it won’t make you a lab scientist but at least you’ll be able to have an intelligent conversation with someone who is. The best addition, in my opinion, are the blue boxes succinctly summarising relevant treatments and drug therapies in all the sections.

The cross-referencing to the most recent clinical Oxford Handbooks is a welcome update (in spite of a couple that refer to OHCM8p.000). I would have liked to see a more thorough reworking of the anatomy section; the diagram of the muscles of the hand remains duplicated a few pages apart. The molecular biology chapter, the one I feel semi-qualified to comment on, is my major complaint. There is no mention of new sequencing technologies and of non-coding RNAs that we are frequently told are the future of the field. Instead Maxam-Gilbert sequencing, a technique probably last done in the 1980s is still covered. Furthermore, ‘junk DNA’, a term surely killed off by the ENCODE project, makes a vampirelike appearance here. [1]

In summary, if you’ve already built a reasonable understanding of the medical sciences and are looking for a one-stop book for reference or revision on the run then this book is a good option. For its convenience and conciseness it is hard to beat OHMS2e. The USMLE crammers like First Aid, offer analogous coverage at an equivalent price but carrying one in your pocket isn’t an option. But beware – as far as OHCM2e is concerned the muscles of mastication are still innervated by CNVIII. Now where is my anatomy book?


[1] Myers RM, Stamatoyannopoulos J, Snyder M, Dunham I, Hardison RC, Bernstein BE, et al. A user’s guide to the encyclopedia of DNA elements (ENCODE). PLoS Biol 2011 Apr;9(4):e1001046.

Book Reviews

A neuroanatomical comparison: Blumenfeld’s Neuroanatomy through Clinical Cases vs. Snell’s Clinical Neuroanatomy

Blumenfeld H. Neuroanatomy through Clinical Cases, Second Edition. Sunderland: Sinauer Associates; 2010.

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…

Book Reviews

Apley’s Concise System of Orthopaedics and Fractures

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.


[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:

Book Reviews

Good Medical Practice: Professionalism, Ethics and Law

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.


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

Book Reviews

The iPhone: Is it an indispensable tool for medical students?

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…

Book Reviews

Oxford Handbook of Clinical Specialities

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 Oxford Handbook of Clinical Specialties (OHCS) is divided into twelve chapters, covering streams such as obstetrics and gynaecology, paediatrics, primary care, psychiatry and accident and emergency, which are part of the core teaching in most medical schools. It also covers a number of other important specialities, such as otolaryngology, dermatology, ophthalmology and anaesthetics.

Made as a companion to the Oxford Handbook of Clinical Medicine – often referred to as the ‘medical student’s bible’ – this book is another in the Oxford Handbook series which provides a solid summary of many clinical streams that will be encountered by medical students as part of general medicine, as well as during speciality rotations.

Like most books in the series, this book is extremely user-friendly. It is divided into different sections based upon fields, with coloured tabs used to help identify each section. Most chapters in the OHCS begin with summary pages which deal with the fundamentals of each stream, allowing students to familiarise themselves with the essentials and identify important learning areas. Following this, most chapters spend one or two pages discussing important clinical entities, covering the common, the classical and the critical conditions that medical students should be aware of. Students who have used other Oxford handbooks will be familiar with the structure used to discuss each condition. Where relevant, the book covers the basics – signs and symptoms, investigations, treatment and management, and complications.

Where this book may fail students is in its lack of detail. While the succinct nature of the OHCS is useful in the first few clinical years, its brevity also means that the level of knowledge expected of more senior students is lacking. For example, the psychiatry section is an area where this textbook fails to compete with a more comprehensive text. Since psychiatry is a stream that is quite removed from the rest of medicine, the brief summary pages on schizophrenia and affective disorders will doubtless leave students wanting. The dermatology section is also underdone, with not enough space in this pocket-sized textbook to include images of the myriad of integumentary conditions, which is vital for the inexperienced student.

Having said this, the OHCS certainly does not purport to be a comprehensive textbook of each of the streams it covers. Tutors will recommend their favourite textbook – the ‘must have’ for each speciality – which will serve to work biceps as much as brains. Like most Oxford handbooks, the selling point for OHCS is that it can fit in one’s pocket and is a handy guide to confirm what has already been learned. Overall this is a great textbook for junior-year students entering the clinical environment for the first time, and a useful reference text for senior students.

Collier J, Longmore M, Turmezei T, Mafi A. Oxford Handbook of Clinical Specialties. 8th ed. Oxford (UK): Oxford University Press; 2009.

RRP $97.95

Conflict of Interest

None declared.

Book Reviews

‘Moore’ than just a doorstop: Clinically Oriented Anatomy vs. Gray’s Anatomy for Students

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