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Procedures for Primary Care Physicians.

John L. Pfenninger and Grant C. Fowle (eds). Mosby-Year Book, Inc, St Louis, Mo, 1994, 1170 pp, $39.95. ISBN 0-8016-6384-9.

Procedures for Primary Care Physicians is a monumental document that rises to the editor's aspiration of providing a "comprehensive text detailing the performance of... procedures. . . " The 2-inch-thick softcover book is divided into 11 major specialty-based sections and details 144 procedures.

Pfenninger and Fowler have assembled a cast of 81 chapter authors that reads like a who's who of procedure-oriented family medicine. Only a few chapters are written by authors outside family medicine. Each chapter covers procedure background, indications, contraindications, preprocedure patient evaluation and education (with Some handouts), equipment, technique, postprocedure care, and complications. Current Procedural Terminology codes for each procedure are thoughtfully included, although relative value units are not. Chapters consistently include equipment supplier addresses, but are less thorough in listing phone numbers and prices for equipment.

The book can reinforce a practitioner's current procedures while providing a path toward the addition of new ones. There is a chapter on every "-oscopy" that can be done without creating an orifice. New and remunerative techniques, such as sclerotherapy, radiofrequency surgery including LEEP, ambulatory bloodpressure monitoring, and no-scalpel vasectomy, are covered. Unfortunately basics such as suture tying, planning of incisions to follow relaxed skin lines, vaginal delivery, use of outlet forceps, vacuum extraction, and rigid sigmoidoscopy are missing.

Indexing and referencing are excellent, and the quality of the writing is superb. Nearly every chapter contains at least one pearl. I was intrigued by the use of an IV catheter for car piercing, a dentist's approach to facial anesthesia, details of intracorporal injections for impotence, and a standard protocol for an inexpensive contraction stress test using nipple stimulation rather than IV oxytocin.

Some of the procedures are beyond the usual Practice of most primary care physicians: for example, myringotomy, Bier block, adult circumcision, tracheostomy, suprapubic catheter insertion, tubal ligation, therapeutic abortion, extensor tendon repair, and lateral anal sphincterotomy. Inclusion of these procedures, however, may bolster a clinician's understanding and thereby improve patient counseling before referral.

It is said that a picture is worth a thousand words. I would add that a bad Picture almost destroys a thousand good words. While the text is unwaveringly superb, I am disappointed at the lack of accuracy and clarity of some of the illustrations, Particularly the line drawings, For instance, a digital block is illustrated as being administered at the level of the nail, Schiotz tonometry is shown with the patient upright rather than supine, and an illustration of a "spinal needle" for a suprapubic tap is obviously a suprapubic catheter over a trocar. Of 925 illustrations, I found 134 that are either inaccurate or unclear.

Novices at skin surgery will find better surgery basics and dressings in Office Surgery for Family Physicians by Pories and Thomas; basics of obstetrics are covered more Comprehensively in Office Procedures in Family Practice: An Illustrated Guide by Mayhew and Rodger; and the philosophy and rationale behind basic office procedures are emphasized more in Gillete's Procedures in Ambulatory Care. None of these books, however cover the newer, more technological procedures.

Most primary care physicians will find this book a valuable, current, comprehensive, and economical addition to their library. A caveat: read the thousand words, but take some of the illustrations with a grain of salt.
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Author:Reynolds, Ronald D.
Publication:Journal of Family Practice
Article Type:Book Review
Date:Mar 1, 1995
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