Family Medicine: Principles and Practice, 7th Edition

Book Title: Family Medicine: Principles and Practice, 7th Edition
Book Editors: Paul Paulman, Robert Taylor, Audrey Paulman, Laeth Nasir, eds.
Publication Information: Cham, Switzerland: Springer International, 2016, 1,865 pp., $599, hardcover

The editors-in-chief are well recognized in the field of family medicine, and well suited to editing a definitive textbook of this nature. Dr Paul Paulman is an active practitioner, teacher, administrator, and professor at the University of Nebraska Medical Center, where he serves as professor of family medicine and assistant dean for clinical skills and quality. Dr Robert Taylor is well known in family medicine, with numerous scholarly contributions and textbooks to his name. He is a professor at Oregon Health and Science University, and has received the Award for Lifetime Contributions to Family Medicine by the American Academy of Family Physicians.

The authors and editors deserve a large amount of praise for the amount of material collected herein. Spanning nearly 2,000 pages, they have provided an up-to-date, readable update of the field. It is a most comprehensive field, and the editors have assembled a formidable array of information, in 133 chapters, to describe it. Each chapter is well organized and clearly written; brief enough to read at a sitting, yet detailed enough to justify inclusion in a textbook of this nature. Some material is sufficiently mature to be considered “classic”, such as the expected chapters on diabetes and hypertension. Other chapters—such as on intimate partner violence, elder abuse, and autism spectrum disorders—provide fresh material to this ever-changing specialty.

Some of the material is clearly organized so as to be readily accessible to the practitioner, such as the material on care of acute lacerations, bites and stings. Others focus more on symptom-based presentations and differentials, such as care of the patient with fatigue. I personally enjoyed the historical perspective in the final chapter, on the evolution of family practice as a specialty.

The scholarly nature of this work and its comprehensiveness are beyond reproach. The fundamental question as to its value lies beyond the book itself, and in its format medium of print delivery. I am unable to answer the question of who is the audience for this work. This is an expensive, heavy, authoritative two-volume text. It can clearly not be used at the “bedside” (a term which itself may need updating). In a busy clinic, if one had to reach for a book, it may be more likely devoted to a specific topic, skill, or modality (such as excellent ones for minor emergencies, musculoskeletal procedures, dermatology photos, or ultrasound).

Now, all these topics appear as chapters in this one two-text volume, yet it seems akin to a pill containing an antihypertensive, a statin, and a hypoglycemic: great when you need all of them, unnecessary when you don’t, and about impossible to update individual components.

For today’s medical practice, this work and other references like it are beautifully crafted anachronisms, at least for contemporary US-based practice. That is not intended as an insult —placing the book in any residency clinical space (as I did) is an experiment all should be able to try. It remained untouched for a month; the current cohort of residents and faculty gravitating to Up To Date1on smartphones for immediate answers; the above specific texts to look up visuals or skills (only if they had to, and if YouTube was down); standard family medicine journals for teaching purposes; and the occasional marked-up review book for those of us beholden to board recertification. I do not believe the e-book version would have fared any better; we are too entrenched in our routines to seek out new sources which our institutions may or may not have paid for.

The best way for this material to be adapted for use by the practicing family physician may be to embed it in places already used, in ways already (and newly) familiar, which will inevitably involve handheld devices at the point of care. Alternatively, it could still serve an important role in settings in the US and abroad where connectivity is minimal and reference books remain a staple of clinical education.

If there is a generational divide in US medical practice, clinical reference volumes are at the intersection—one rapidly receding in the distance. In the future, should there remain such a place as a medical library with books in it, this work surely belongs in it as one of the finest examples of family medicine references. For me, however, it is akin to the philosophical question of the (1,855-page) tree falling in the forest and no one being around to hear it. I am not sure what sound it makes.