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Smith, Roger P. Gynecologic decision making. 1st edition. Philadelphia: W.B. Saunders Publishing Company, 2001.
BOOK REVIEWS
FERTILITY AND STERILITY威 VOL. 76, NO. 3, SEPTEMBER 2001 Copyright ©0 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A.
Smith, Roger P. Gynecologic Decision Making. 1st Edition. Philadelphia: W.B. Saunders Publishing Company, 2001.
brief management of simple and common conditions, physicians with expertise would be dismayed by the overall general simplification necessary to present information in this format.
There has been a positive trend in clinical medicine to include evidence in our clinical decision making. Evidencebased medicine is now routinely discussed in our office practice and on our clinical wards. In this book, Dr. Smith attempts to simplify some of the common decision-making schemes we undergo when seeing patients. This book is a series of schematics to be used to help diagnose and treat many common gynecologic disorders. The book uses a decision flow chart to identify when a branch point or decision process is encountered and, as much as possible, uses evidence to help us make this decision.
In summary, this is a comprehensive textbook in that it covers the diagnosis and therapeutic decision making for a large variety of gynecologic topics. However, the detail involved in this book limits its usefulness to a gynecology subspecialist and, perhaps, even to a busy knowledgeable general gynecologist. This book may be a good resource for a general practitioner or family practitioner who does not encounter gynecologic problems on a routine basis. This text goes a long way to promote the concept of decision algorithms to standardized clinical care and to advance evidencebased medicine. However, given the complexity of clinical medicine we face on a daily basis, this book falls short of its mark.
This text is divided into 126 sections covering gynecologic situations that we may encounter in our practice. There is an extensive coverage of topics, which range from abnormal Papanicolaou smears, adnexal masses, common gynecologic cancers, urinary incontinence, and even includes sections on assisted reproduction and reproductive endocrinology. Each section includes a short introduction and a schematic outlining decisions and possible outcomes. Each decision is numbered to correspond with a brief description of information that should be considered and the evidence (if any) that is present to assist in this decision. The information is generally comprehensive yet by necessity extremely simplified. A limitation to this text is that all conditions we face in clinical practice are not conducive to a flow chart schematic. In truth, many parts of work-ups are performed concomitantly and multiple decisions are often encountered simultaneously. Thus, by necessity, this text suffers from less than in-depth descriptions of each clinical situation encountered. In may situations, forcing clinical diagnosis into a schematic leads to questionable diagnostic criteria. For example, in the evaluation of ovarian cysts, by following the decision tree the presence of bilateral ovarian cysts with an elevated LH equates to a diagnosis of polycystic ovarian disease. In addition, the diagnosis of headache proceeds very quickly to lumbar puncture or computed tomographic scan before the possible differential diagnosis of a migraine. Other illogical conclusions from these schematics include suggesting GIFT as a treatment for women with tubal factor infertility. Many other reproductive endocrinology disorders described in this book are very nonspecific with a simplified list of diagnostic tests and differential diagnoses. Although this book can be a good reference to the
644
Kurt Barnhart, M.D., M.S.C.E. Assistant Professor, Obstetrics and Gynecology, Senior Scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Medical Center Philadelphia, Pennsylvania PII S0015-0282(01)01965-3
New York Task Force on Life and Law. Genetic Testing and Screening in the Age of Genomic Medicine. Albany, NY: Health Education Services, 2001:1– 406. Price $10. A book without a glitzy cover and written by a “committee” of over 50 individuals would not be expected to have been designed to dazzle the reader. In addition, the report is tethered to the New York Task Force on Life and Law as a policy-making document for the New York state legislature and funded by the National Human Genome Research Institute (grant 5 RO1HGO1555) and the Greenwall Foundation. Given this spartan recommendation, the reviewer started out feeling certain to be bored by the prospect of reading a document designed for public policy making. To my surprise, all of this is simply camouflage designed to discourage the timid reader. Don’t be fooled and torpedo the experience; the report is a factory of facts. There are no contrivances or performances in progress. In fact the text allows the reader to get more fully and precisely into the protean language of genetics. The most striking aspect of the book is the quality of the writing. A wide variety of technical definitions are covered in a concise, clear, and systematic style that makes the text readable for a wide audience. The report is crafted in
FERTILITY AND STERILITY威 VOL. 76, NO. 3, SEPTEMBER 2001 Copyright ©0 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A.
Smith, Roger P. Gynecologic Decision Making. 1st Edition. Philadelphia: W.B. Saunders Publishing Company, 2001.
brief management of simple and common conditions, physicians with expertise would be dismayed by the overall general simplification necessary to present information in this format.
There has been a positive trend in clinical medicine to include evidence in our clinical decision making. Evidencebased medicine is now routinely discussed in our office practice and on our clinical wards. In this book, Dr. Smith attempts to simplify some of the common decision-making schemes we undergo when seeing patients. This book is a series of schematics to be used to help diagnose and treat many common gynecologic disorders. The book uses a decision flow chart to identify when a branch point or decision process is encountered and, as much as possible, uses evidence to help us make this decision.
In summary, this is a comprehensive textbook in that it covers the diagnosis and therapeutic decision making for a large variety of gynecologic topics. However, the detail involved in this book limits its usefulness to a gynecology subspecialist and, perhaps, even to a busy knowledgeable general gynecologist. This book may be a good resource for a general practitioner or family practitioner who does not encounter gynecologic problems on a routine basis. This text goes a long way to promote the concept of decision algorithms to standardized clinical care and to advance evidencebased medicine. However, given the complexity of clinical medicine we face on a daily basis, this book falls short of its mark.
This text is divided into 126 sections covering gynecologic situations that we may encounter in our practice. There is an extensive coverage of topics, which range from abnormal Papanicolaou smears, adnexal masses, common gynecologic cancers, urinary incontinence, and even includes sections on assisted reproduction and reproductive endocrinology. Each section includes a short introduction and a schematic outlining decisions and possible outcomes. Each decision is numbered to correspond with a brief description of information that should be considered and the evidence (if any) that is present to assist in this decision. The information is generally comprehensive yet by necessity extremely simplified. A limitation to this text is that all conditions we face in clinical practice are not conducive to a flow chart schematic. In truth, many parts of work-ups are performed concomitantly and multiple decisions are often encountered simultaneously. Thus, by necessity, this text suffers from less than in-depth descriptions of each clinical situation encountered. In may situations, forcing clinical diagnosis into a schematic leads to questionable diagnostic criteria. For example, in the evaluation of ovarian cysts, by following the decision tree the presence of bilateral ovarian cysts with an elevated LH equates to a diagnosis of polycystic ovarian disease. In addition, the diagnosis of headache proceeds very quickly to lumbar puncture or computed tomographic scan before the possible differential diagnosis of a migraine. Other illogical conclusions from these schematics include suggesting GIFT as a treatment for women with tubal factor infertility. Many other reproductive endocrinology disorders described in this book are very nonspecific with a simplified list of diagnostic tests and differential diagnoses. Although this book can be a good reference to the
644
Kurt Barnhart, M.D., M.S.C.E. Assistant Professor, Obstetrics and Gynecology, Senior Scholar, Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Medical Center Philadelphia, Pennsylvania PII S0015-0282(01)01965-3
New York Task Force on Life and Law. Genetic Testing and Screening in the Age of Genomic Medicine. Albany, NY: Health Education Services, 2001:1– 406. Price $10. A book without a glitzy cover and written by a “committee” of over 50 individuals would not be expected to have been designed to dazzle the reader. In addition, the report is tethered to the New York Task Force on Life and Law as a policy-making document for the New York state legislature and funded by the National Human Genome Research Institute (grant 5 RO1HGO1555) and the Greenwall Foundation. Given this spartan recommendation, the reviewer started out feeling certain to be bored by the prospect of reading a document designed for public policy making. To my surprise, all of this is simply camouflage designed to discourage the timid reader. Don’t be fooled and torpedo the experience; the report is a factory of facts. There are no contrivances or performances in progress. In fact the text allows the reader to get more fully and precisely into the protean language of genetics. The most striking aspect of the book is the quality of the writing. A wide variety of technical definitions are covered in a concise, clear, and systematic style that makes the text readable for a wide audience. The report is crafted in