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One can easily infer that the subject-oriented medical school curricula implicitly presume that patients arrive in the consultation office with a diagnostic label attached. Such may actually be the situation in universities and referral centers and consequently the subject-oriented books would be the appropriate references to use. In real life, however, clinical practitioners are faced with patients presenting with generic problems and the physician has to work his way through an analysis algorithm of a specialty in which he may not have received full training. The symptom-oriented or problem-oriented approach has a lot of merit and is worth adopting by medical schools. References based on this approach are few and far between, even in this age of publications explosion. The second edition of "The Handbook of Symptom-Oriented Neurology" comes as a welcome addition to the endeavor of bringing this approach into wider use. It is touted as a quick reference to help primary care physicians in handling neurological emergencies. It is well organized and clearly written. It fulfills the promise of being an easy reference where a particular question can be looked up quickly. The line drawings are quite clear, self-explanatory and very helpful in presenting the technique of clinical examination or demonstrating clinical signs. A purist may see some chapters as a vestige of the subject-oriented approach. The chapters on multiple sclerosis, diseases of the cervical spine and infections of the nervous system are examples of labels that rarely come as a presenting complaint to the primary care physician. What I find particularly interesting is the chapter on emergencies and the appendix on symptom-oriented neurologic examination. The latter should probably replace, or merge with the first chapter on neurologic examination to avoid repetition. The book is cut in a size that fits in a coat pocket but its 600 plus pages makes it a little bulky. The way technology is advancing, it may become possible to publish the next edition on an IC card to fit in an expansion slot of one of the pocket or palm-top minicomputers. Although the stated target readers are the primary care physicians, it will be a useful manual as well for the house staff in neurology training programs and medical residents on neurology rotations.

annals of saudi medicine/annals of saudi medicine

The Handbook of Symptom-Oriented NeurologyThe Handbook of Symptom-Oriented Neurology, by William Olsen, Roger Brumback, Vasudera Iyer and Generoso Gascon. Mosby-Year Book, Inc. St. Louis, MO, USA. 2nd Edition, 1994. US $29.95. ISBN: 0-8016-7779-3