Preface to the Sixth Edition

Textbook of Physical Diagnosis: History and Examination has been written for students of health care who are learning to communicate effectively with patients, to examine patients, and to assess their medical problems. Although 20 years have passed since the publication of the first edition, this text still offers a unique approach to physical diagnosis. By discussing pathophysiology of disease and emphasizing the humanistic element of health care, I attempt to show the importance of the ''old-fashioned'' doctor's approach to the patient. ''The primary aim of this textbook,'' as stated in the Preface to the First Edition, ''is to provide a framework for the clinical assessment of the patient in a humanistic manner.'' The book, then and now, focuses on the patient: his or her needs, problems, and concerns.

The history and physical examination must not be seen as procedures performed by a robot but rather as a process that requires interpersonal awareness as well as technical skill. In this era of extraordinary advances in diagnostic modalities, procedures and tests have been emphasized, while the importance of the history and physical examination has been minimized. It is well known, however, that among the most valuable and least costly medical evaluations are the history and physical examination. This book focuses on how to offer the best medical care through the art of interviewing and physical examination.

The Sixth Edition represents a major revision based on a complete review of the field of physical diagnosis. The chapters have been reviewed and modified where appropriate. Extensive changes have been made to the pediatric chapter and to the chapter on the pregnant patient. As times change, so do standards of physical diagnosis. Therefore, several of the tests indicated in the previous editions have been either modified or eliminated. The bibliography has been updated. This edition includes a new chapter on the focused history and physical examination, since this skill is so important today with the introduction of the USMLE Step 2CS examination.

Another feature of this edition is the inclusion of a DVD-ROM that contains step-by-step demonstrations of the complete physical examination of the man and of the breast and pelvic examinations of the woman. The DVD-ROM, playable on your computer as well as on a DVD player, also illustrates the pediatric examinations of the newborn and of the toddler, as well as a new section on the neurologic evaluation of the toddler. Using standardized patients, the DVD-ROM shows history-taking with an adolescent and her mother, as well as interviewing techniques regarding sensitive topics with a geriatric patient. These sensitive topics include a discussion of advance directives (i.e., health care proxy determination and living wills), a mental status examination of a patient with cognitive impairment, and a scenario showing how to give bad news. In addition, this new edition also contains scenarios demonstrating the focused history and physical examination of a young man with abdominal pain, x Preface to the Sixth Edition counseling a woman about health-related issues, and a demonstration of a pediatric telephone consultation. The DVD-ROM coupled with the textbook provide a comprehensive clinical reference for the understanding of the organization and fluidity of the complete assessment of the patient.

The book is richly illustrated with over 900 photographs and line art. Many of the original black-and-white images demonstrating the techniques of the examination have been replaced with color images captured from the DVD-ROM videos.

In addition, this Sixth Edition includes an accompanying website on Student Consult, which is an online interactive learning platform presenting a collection of over 50 Elsevier textbook titles with a wide array of ancillary materials. The website features fully searchable text; integration links that will seamlessly connect the user to additional and related content in other Student Consult titles; an image library, with figures that can be easily downloaded into PowerPoint; and supplementary material such as audio clips. Users can gain access to the online version of this book by going to www.studentconsult.com and entering the unique PIN code provided on the inside front cover of this book.

The health care provider of today must be able to synthesize basic pathophysiol-ogy with humanistic medical care. As the medical profession continues to be under great scrutiny, we must emphasize an empathetic approach to patient care, recognizing the role of culture in illness and using modern technology only to enhance our clinical assessment, not to replace it. We must always remember that a patient is a person suffering from disease.

I hope that you will find this Sixth Edition of Textbook of Physical Diagnosis: History and Examination to be reader-friendly, comprehensive, and an exciting addition to your library.

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