Practical Gynecology: A Guide for the Primary Care Physician. (Book Reviews).

Editors: Janice Ryden, MD, and Paul D. Blumenthal, MD

Publisher: American College of Physicians, Philadelphia, 2002

Publication of this book is a direct result of concerns that internal medicine residents have previously described their basic gynecologic education as inadequate. At Johns Hopkins University, a team of gynecologists and internists assembled to address the issue which resulted in a formal gynecologic curriculum for internal medicine residents that was eventually expanded to the publication of this book, directed towards the non-gynecologist.

While Dr. Ryden is an internist and Dr. Blumenthal, a gynecologist, the contributors list also reveals balance between internal medicine and gynecologic contributors.

For the last several years, gynecologists have been placing increased emphasis on primary care in their patient care. The residency review committee for obstetrics and gynecology now requires each resident to experience six months of primary care training during his or her residency care program. An increased emphasis in gynecology by internists would therefore provide patients with increased options. Patients with gynecologic concerns could select the gynecologist, internist, or family physician with which they had the greatest comfort level. This book therefore represents an excellent cross specialty collaboration which can be of benefit to patients.

This 621 page book with 22 chapters has a wide variety of appropriate topics, ranging from the very basic gynecologic examination to the more sophisticated subjects such as hormone replacement therapy and infertility. The chapter on Lesbian Health Issues discusses a topic unfamiliar to many physicians while the chapter on Preconception Care covers a subject which should be required reading by all physicians who see women during their childbearing years. Obstetricians are frequently frustrated when patients are seen for the first prenatal visit with conditions that have not been addresssed and have already affected the pregnancy at the time of the visit.

Although this book is thorough, I believe some more time could have been spent on the topic Congenital Anomalies to ensure that the primary care physician is familiar with the broad range of potential presentations for these conditions. Also, there are chapters on Domestic Violence and Sexual Assault, with the latter being mentioned briefly (in my opinion, it could benefit from its own chapter given the large number of patients who are victims of this condition).

This book is well organized, thorough, well written, and easy to read. Generous use of figures and algorithms assist with the synthesis of information. Many chapters have brief patient case reports that improve the reader's understanding. It could become a valued reference on the office bookshelf of internal medicine physicians or family physicians.