Fauci. Harrison's Principles of Internal Medicine

[Guest Ian Wong]

Harrison's Principles of Internal Medine, 14th Ed. Fauci, A. S., Braunwald, E., Isselbacher, K. J., Wilson, J. D., Martin, J. B., Kasper, D. L., Hauser, S. L., Longo, D. L. 1998. The McGraw-Hill Companies, Inc. Toronto.

 

ISBN: 0-07-020291-5 (Combined Single Textbook)

ISBN: 0-07-912013-X (Both Volume 1 and Volume 2, separate books)

Chapters/Indigo.ca price: $193.75

Chapters/Indigo.ca price: $215.45

Pages: 2570

 

Ever since getting into med school, I've been hearing jokes that this book is the end-all, and be-all of clinical medicine. Perhaps this is due to its extremely impressive and unwieldy size. Most medical textbooks make great door-stops; this 2570 page beast could probably stop a 747 rolling downhill! The book can either be purchased as one large textbook, or divided into a two-volume set (slightly more expensive). I was recommended to buy the two-volume set, as frequent use of the book might damage the binding. Needless to say, I haven't used it enough to see any binding wear.

 

For the clinicians, Harrison's is probably fairly useful as a reference, although I get the sense that peer-reviewed journal articles and evidence-based studies are what most clinicians turn to for current state-of-the-art guidelines. In addition, as a computer junkie myself, I really see a medical future dominated by access to information through electronic media. Whether this takes the form of handheld computers, or easily-accessible medical literature portals like www.mdconsult.com or Medline or perhaps a wireless fusion of the two, I honestly believe that the times of referring to large and heavy textbooks is going to fade as handhelds get larger memory capacities and faster processors capable of quick on-the-fly searches while in the office or on the wards.

 

Consequently, now I think perhaps my approach in Med 1 when I bought Harrison's was all wrong. Back then, I thought that buying Harrison's as an investment would be ideal as I could use it while progressing through medical school, and then continuing on into residency and practice. Unfortunately, I discovered fairly early-on that Harrison's is not a reader-friendly text to the neophyte medical student. It uses an incredible amount of medicalese without explanation of the terms, as it is implied that you are already conversant with the medical lingo. As a result, you will be using a large medical dictionary to decode the terms used by an even larger book! How inefficient is THAT?! As a result, you won't find this textbook very useful until you become more familiar with the terminology as you encounter it through your lectures and PBL.

 

Therefore, by the time you have mastered the medical language enough to take advantage of this book, you will probably be somewhere in Med 2, and will already have become used to other, more readable texts to find relevant medical information, such as the Merck Manual or Robbins. If you are investigating the physical signs and symptoms that you need to make that diagnosis, then a clinical skills textbook will often suffice. Harrison's is also extremely text-dense, with few pictures or diagrams, making it an even tougher read. Those that appear are almost universally black and white. Finally, by the time you can use Harrison's effectively, there may also be an updated edition (they seem to print a new edition every 3-4 years).

 

As a result, my suggestion is that you hold off on purchasing this book. I think it is totally unnecessary to purchase when you are still relatively new to medical school. The same problems of inefficient time usage of handcopying notes out of this text for PBL research purposes also applies. However, as with the Merck Manual, there is a CD-ROM version which allows you to search for, and then print articles. That combined with a quick read and high-lighting is an ideal way to approach learning issues. Finally, there is an on-line version of Harrison's with a free trial period, so you can sign up for it and see how useful it really is before committing to a purchase. I believe the UBC Library also has a subscription for UBC students, so you might want to check whether your med school has already paid for your access. Check it out at: www.harrisonsonline.com

 

I'd also just like to mention that Harrison's has released a mini-version of its text for the PalmOS; I don't know whether a similar product has been developed for the Win CE handhelds, but I suspect there is. For the PalmOS, this is a 1 Mb text document that is searchable. Compared to the handheld version of the Merck Manual at 4.5 Mb, and you quickly see that this version is markedly less detailed. I have mini-Harrison's on my Handspring Visor Deluxe, but when I need to look up a specific disease, I use the Merck Manual first, and mini-Harrison's second.

 

In summary, Harrison's is a book that you can probably hold off on purchasing. It is not a book that you will find too useful in Med 1, and in my opinion contains information that can be obtained through other more readable textbooks. Despite this, I'm enough of a weenie to have kept this book (rather than selling it back like I probably should have done), just so I can stick it on my bookshelf and impress all my non-med friends. The reality is that I've probably only used this book for research purposes once this year. The rest of the time, I use the CD-ROM version, the handheld version, or I just go to another book that describes the disease better.