Book Reviews

This book was originally written with the objective of producing a text which would be ‘instructive, enjoyable and stimulating’ for medical students. It is written in an easy conversational style and it is full of pithy sayings and useful tips which are complemented by its simple cartoons. Despite these positive aims and achievements I found this a frustrating text. My frustrations began with the title ‘Paediatric Clinical Examination’, because there is extensive discussion on history taking and the book is really about ‘assessment’ of children, including interpretation of history. Details of history taking and physical examination are frequently intermingled throughout the text without any obvious systematic approach. The approach reflects the intuitive approach taken to clinical medicine by some great clinicians, which works well in their hands, but maybe confusing for those less gifted or experienced. Areas of clinical examination in paediatrics which are important parts of any paediatrician’s skills, and in which there have been important studies and new knowledge on the significance of clinical findings stand out as not keeping up to date. For instance, the segment on assessment of hydration fails to mention capillary return as a measure of perfusion and does not differentiate the relative importance and reliability of the clinical signs of dehydration. The chapter on anthropometry is vague and imprecise, and recommends unacceptable methods such as use of a tape measure for assessment of crown/heel length. The segment on assessment of the acutely ill infant details worrying symptoms, but fails to provide any systematic approach to physical assessment. Overall this text is a disappointment. It falls a long way short of being useful for paediatricians in training. It cannot be recommended for undergraduates because of its lack of precision, its inappropriate practices and its failure to have kept up with changing understanding of physical assessment.