Resumes and personal statements for health professionals

Book Reviews No Easy Choices---The Difficult Priorities of Health Care. Report by the Health Care and Medical Priorities Commission, Stockholm, 1993.

Authorship: In 1992 the Swedish government charged the Health Care and Medical Priorities Commission with the task of considering "the role of health care and medical services in the welfare state and to highlight fundamental ethical principles" to furnish guidance concerning the priorities of health care. In 1993, the Priorities Commission published its first report, " N o Easy Choices--The Difficult Priorities of Health Care." The members of the Commission are primarily Swedish legislators representing a broad range of political parties. Expert advisors to the Commission are physicians and senior administrators in the health field. The Commission canvassed a number of national authorities, organizations, and health care personnel through meetings and questionnaires. After this preliminary report is circulated for general public debate, it is the Commission's plan to issue a final report. Overview: This 133-page book provides a fascinating glimpse into a welfare society that has developed a medical care system vastly different from ours. It offers a unique opportunity to examine a socialized medicine model and its consequences as we consider national health care reform in the United States. This view is a sobering one: it illustrates the challenges that are confronting all health care systems due to the realities of financial and resource constraints. Any system either legislated by our government or evolving through marketplace reform will be faced with the ultimate issue of prioritization of limited resources and the concomitant ethical questions. As physicians, we currently make difficult choices on a daily basis in our practices; however, we have done so without explicit public debate or ethical guidance. As a culture and a society, we are just beginning to grapple with this inevitable task. The report begins with a useful but somewhat tedious "Background" section that reads like a cross between a law textbook and an ethics textbook. The third chapter of this section, however, brings the philosophical discussion back to clinical relevance. Nine specific case vignettes are presented to illustrate prioritization dilemmas that are an everyday occurrence in medical practice. The cases are provocative and many could easily be borrowed from the daily chronicles of any emergency department in the United States. The questions are familiar: In a world of cost containment, how much weight should the patient's desire for a diagnostic test carry, as opposed to the physician's assessment of efficiency and expense? Are age and social factors to be considered in making priorities? Who is responsible for the demented elderly patient who has no close relatives: a medical service or a social service? This chapter would he an excellent starting point for any medical school ethics class. Another interesting chapter in the background section discusses the models of prioritization that have been developed in other countries. Models from Norway, the Netherlands, New Zealand and the United States are presented. The reflection of our own culture through the eyes of the Swedes is a valuable but uncomfortable experience. Are we as materialistic as we sometimes appear? Should medical care be a universal right? Have we made decisions that reflect the values of our society? It is clear that the process of establishing bioethical values is in its infancy in the few countries that have had the resolve to bring the moral aspects of medical decision making to public dialogue. The main thrust of this report is found in a deceptively simple chapter entitled "Ethical Principles." In 7 pages, the commission proposes the three principles on which health care priorities should be based. The first principle reflects the values of the Swedish people and is entrenched in the notion of universal human equality and the right to medical care on equal terms for the entire population. 598

The second principle is based on the belief that resources should be allotted where needs are greatest, which often means devoting special attention to the needs of the weakest. The third principle is the one we are most familiar with: when choosing between different activities, one should opt for that which, all other things being equal, has the greatest cost-efficiency. Clinical research is paramount to applying this principle, and this report repeatedly emphasizes the central role of research in developing health care priorities. The ethical principles are then translated into proposed guidelines of prioritization that the authors admit appear at first glance as an "oversimplification of a complex reality." However, in chapter 14, the guidelines are then applied to the nine cases originally presented, illustrating the fundamental guidance provided by the ethical principles. General Recommendations: I highly recommend this book for anyone who wants to take an active role in the health reform debate that faces us both as physicians and as consumers. Priorization in medical care is inevitable regardless of how we eventually tackle the problems in our health care industry. We have a lot to learn from the Swedes about the process of formulating and publicly debating the values of a society. As emergency physicians we may be in a better position than other health care professionals to contribute meaningfully to the discussion of priorization. Setting priorities, after all, is the essence of our daily clinical practice. This report provides an important perspective to all of us who need to participate now. STEPHANIE B. ABBUHL, MD

Medical Director, Emergency Department University of Pennsylvania Medical Center Philadelphia, PA Resumes and Personal Statements for Health Professionals. James W. Tysinger, PhD. Galen Press, 1994.

Authorship: This delightful and concise book is written by Dr. James Tysinger, from the Office of Medical Education at the University of Texas Southwestern Medical Center at Dallas. The author has extensive experience in assisting health professions personnel in the area of career development and is well qualified to serve as the coauthor of this textbook. Overview: The book is intended to appeal both to the neophyte first applying to a health professions school or training program and to those who are pursuing their interests in well established academic careers. Strengths and Weaknesses: Dr. Tysinger succeeds admirably in his task, uniquely spanning the realm from entry level student to Professor seeking a Chair in a health sciences profession. The textbook spans 208 pages divided into 12 chapters, comprising each step of the process of compiling a resume, including personal statements, personal marketing inventories, marketing strategies, and detailed, step-by-step plans along the way. There is even an important and entertaining chapter regarding "Cover and Thank-You Letters," which appropriately emphasizes how best to handle such issues. The book is well illustrated and contains worksheets throughout that help assure the ability to follow the step-by-step approach included in the text. There are ample numbers of example resumes and curricula vitae listed in the textbook, covering entry level applications through those of senior healthcare professionals. As an editor of several textbooks in emergency medicine, I found the information to be extraordinarily well organized and tersely but entertainingly written. I was particularly impressed with the specific advice on how to continue to strengthen and build on the resume and personal statement. General Recommendations: This concise and well-written book should appeal to all levels of emergency medicine professionals. It

BOOK REVIEWS

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would make an excellent addition to any individual’s library and should be required reading for medical students, residents, and faculty members who are attempting to apply for new positions. At its cost of $15.95, it is a real bargain. I plan to order copies for the residents in our emergency medicine training program immediately. THOM MAYER, MD Emergency Medicine Fairfax Hospital Falls Church, VA Georgetown University School of Medicine Washington, DC Emergency Care of the Compromised Patient. Robert D. Herr, Rita Cydulka, editors. Lippincott, 1994. Overview: What should be considered when a patient presents with erythema around a colostomy site? What are the complications of percutaneous endoscopic gastrostomy (PEG) tube placement? What are the most common complications seen in a patient with cystic fibrosis? Although these situations are not seen on a daily basis by most emergency department (ED) physicians, they may be seen by any ED physician at any given time. The authors noted a void in most standard textbooks for managing the chronically ill and attempt to till this void with a textbook on caring for these patients. The book “is written, edited and indexed for quick access, designed specifically for emergency physicians . . who don’t have the time or luxury of time to read an entire chapter before making critical decisions.” The editors assembled a collection of authors, many of whom are practicing emergency physicians, to accomplish this task. Strengths: The textbook begins with a chapter on the neonatal intensive care unit graduate and ends with one discussing the nursing home patient. In between, chapter topics range from compromised central nervous systems to problems with compromised integument and social settings. It describes care of patients with chronic conditions, those on long-term medications, and those with prosthetic or indwelling devices. The book is organized for rapid access. Each chapter is divided into subsections that summarize, in general terms, the condition or device. This is followed by discussions on clinical presentation, emergency evaluation, ED management, disposition, and summary. The sections are highlighted in bold text, which makes it particularly easy to rapidly skim for information. As such, it is extremely beneficial for ED physicians and would be heipful to family practice physicians and internists as well. Weaknesses: If there is a weakness in the text, it is in the lack of depth of any given subject. This was not the intent of the authors and does not hinder the book’s usefulness as an easy-to-use and well-referenced ED text. General Recommendations: I used the text during clinical shifts to test its value in managing chronic problems encountered in our tertiary care facility. It is well indexed, easy to read, and useful for obtaining information. I found that the book met its stated objectives. It is a useful text to have in one’s personal library and an absolutely invaluable source book in any ED. JAMES

A. PFAFF,

MD

Chief, Department of Emergency Medicine Brooke Army Medical Center San Antonio, TX Practical Fracture Treatment, 3rd edition. R. McRae, editor. Churchill Livingstone, 1994. Overview: As an emergency medicine physician, I require a text that succinctly covers the diagnosis and various treatment options of orthopedic entities. Radiographic views as well as physical examination must be discussed. Casting techniques, aftercare instructions, and potential pitfalls are also essential. The organization must

allow easy access to the desired information. This text met all of these requests when used in the heat of battle. Strengths: This text’s third edition is designed as a comprehensive review of fractures as written for the medical student. It is organized into two sections consisting of general principles and regional injuries. The general principles section brings the reader with no prior knowledge up to speed in the basics of fracture management. This section is divided into five chapters covering a broad expanse of information, from principles of fracture management to pathology to internal fixation. The second section, regional injuries, allows for a more in-depth review of individual anatomic areas in 10 chapters. The regional injuries section is divided into little vignettes on each separate diagnosis, covering mechanism of injury, diagnosis, pathology, treatments, aftercare instructions, and common complications. Each topic is covered by text and illustrations that include drawings and/or radiographs, which are arranged to fit six combinations to a page. Each chapter has its own separate table of contents, allowing for quick access to the desired information. An additional chapter reviews the organization of a fracture clinic. The 17-page index allows acquisition of information along general terms (femoral shaft injury), as well as more specific topics (Grosse-Kempf intramedullary nails). Each chapter contains a review quiz at the end. The text is not specifically set up for emergency medicine physicians; however, acute treatment of a variety of fractures is well covered. I attempted to use the text while in the department as a quick reference. I found that it gave me a quick review of the entities I had encountered, which included a trimalleolar fracture, open book pelvis fracture, boxer’s fracture, and garden type I femoral neck fracture. The book offered an easy-to-read ready reference that allowed timely treatment of patients. Weaknesses: In criticism of the book, I found a few points I would alter. There is a very brief and, in my opinion, too simple explanation on evaluation and stabilization of a multiple trauma patient in the first section. Although the author presents several treatment options, I disagree with some of the methods mentioned, such as the Hippocratic method of reduction of anterior shoulder dislocation. I also believe that some of the techniques should not have been included because they require more explanation than given for their use. Traction with Blackburn calipers for cervical instability is an example. I noticed that I tended to only skim the areas that discussed internal or external fixation. However, they did help in providing the patient with a brief explanation of what further treatment may involve. General Recommendations: In summary, this text should be considered as a quick review for the treatment of various fractures. Too much space and effort is applied to the surgical repair of fracture management, but then the book was not written specifically for emergency medicine. There are no references made to current literature. Although it is not essential to the practice of emergency medicine, it would be a welcome addition. DAVID E. MANTHEY, MD STEVEN E. HOLT, MD

Emergency Medicine Residency Joint Military Medical Centers San Antonio, TX Pediatric Trauma: Initial Assessment and Management. Edward G. Ford, MD, Richard J. Andrassy, MD. Saunders, 1994 Authorship: The editors of this textbook are widely respected authorities in the field of pediatric surgery. Both have published extensively in pediatric surgery and in pediatric trauma. Among the 18 authors, there are no emergency physicians or pediatric emergency physicians represented. Overview: The editors indicate that their textbook is designed to provide “a framework for the initial assessment and management of pediatric victims with traumatic disease” and is therefore targeted