Chawla. U of Toronto's Essentials of Clinical Examination

[Guest Ian Wong]

Essentials of Clinical Examination Handbook, 2nd Ed. Chawla, A., Somani, R. 1999. The Medical Society, Faculty of Medicine, University of Toronto. Toronto.

 

ISBN: Unlisted/private book

Chapters/Indigo.ca price: Unlisted/private book (We put together a group purchase for this book as a class, and I think the final price was around $20)

Pages: 200

 

This is a wonderful pocketbook put together by current and past medical students at the University of Toronto (home also to the Toronto Notes textbook). The book measures 13 cm x 19 cm x 1.4 cm, easily small enough to fit into your white coat pocket, and therefore portable enough to actually have with you while on the wards. Where I see this booklet being most useful is as a quick reference to ensure that you havent forgotten any important parts of your current examination. One of the toughest parts of clinical examination, for me anyway, is developing and sticking to a organized series of examination steps that helps you from accidentally omitting an important facet to an organ system exam.

 

For example, when I was learning to do a complete Cardiovascular exam, Id get the vitals, heart sounds, and JVP, but would forget to check for fingernail clubbing, or ankle edema/peripheral pulses because those details occur at the patient's extremities, far away from the chest and neck. This book will help keep you on track, particularly because it's compact enough to actually have with you while you are in the hospital, or doing your Clinical Skills classes.

 

With that said, you shouldn't rely on this book as your primary source for learning clinical examination skills. You would be best served to learn the actual mechanics of a physical exam (eg. how to do a proper fundoscopic exam) from a larger and more detailed book such as Bates or Talley and O'Connor. This book is directed towards a different niche, that of being a comprehensive Clinical Skills reference book compact enough to actually keep with you. For that purpose, this book is excellent. There are a number of useful tables in each organ system section, for example, a short table on cranial nerves and their functions in the Neurological exam section.

 

The major drawback of this book is the lack of colour drawings. The entire book is presented in black and white, with line drawings only. Colour drawings would be extremely useful when you are trying to pick out a given abnormality for the first time before you gain familiarity with that condition, and can then recognise it without needing to use a reference book. For example, a colour picture of an abnormal fundus would help you decide if papilledema is present in a person in whom you suspect increased ICP. Another possible drawback is that due to the book's brevity, there may be a little less detail in the actual mechanics of how you would observe, or elicit signs and symptoms from your patient. For example, in the Respiratory exam section, they constantly refer to the six positions where you should auscultate and check for tactile fremitus, but never actually tell, or diagram out for you where those six positions are. You can minimize these drawbacks by supplementing your reading with a larger Clinical Skills textbook, and then bringing this book along as a reminder.

 

I think this book is an excellent companion book to help you out while conducting histories and physicals until your routine is consolidated for each major organ system evaluation. I believe that you will find this book useful both in Med 1 and Med 2 when you are learning the basics of clinical examination, and that it will continue to be helpful as a quick reference on the wards in Med 3 and Med 4. I plan on keeping this book close by. That, combined with its minimal price (compared with other medical books in general, and the ability to make a group rate purchase), make it a very strong value.

 

There is now a third edition, which I have just purchased, and it looks to be significantly better than the second edition, which was already pretty decent.