Gynecologic Decision Making By Roger P. Smith W. B. Saunders Company, Philadelphia, 272 pages, $49.00, 2001
pelvic pain has a comparably complex algorithm that contains multidisciplinary tools such as the Beck depression inventory. This easy-to-read paperback contains algorithms on the right-hand pages. Left-hand pages contain introduction, footnotes to the algorithm, and pertinent references. There is ample space for notes to be written in the margins. The index and table of contents are well organized and useful. I recommend the book to all group practices and individual clinicians as a source for evaluating their practices. The evidence-based algorithms will challenge clinicians to improve their own outcomes and to consider the economic impact of these and similar algorithms on capitated practices. They contribute to our specialty’s continuous quality improvement. Any improvements to the book will come as the algorithms are evaluated and reassessed.
We are all familiar with the terms clinical pathways, best practices, evidenced-based medicine, and disease management. We have participated in their promulgation, evaluation, criticism, and distribution. Dr. Smith brings forth a nice codification of ambulatory gynecologic practice that will serve as a starting point for practitioners who wish to evaluate their own clinical pathways. His clearly illustrated algorithms of more than 120 clinical conditions are clinically sound and appropriately referenced. References include current gynecologic textbooks, articles from peer-reviewed journals, and technical bulletins from the American College of Obstetricians and Gynecologists. Complex medical problems such as anemia are outlined with a reference to a hematology text. Clinicians and group practices will recognize that the internist or hematologist they consult will likely modify the algorithm. The algorithm for pelvic mass has clear end points for appropriate medical and surgical diagnosis and therapy. The more complex question of chronic