DeGowin's Diagnostic Examination

Rating:
Summary: CONCISE & USEFUL
Review: Compact & concisely informative, this is one of my best purchases. The book lives in the car for ready reference & gets so much use, the cover edges are wearing down

Rating:
Summary: CONCISE & USEFUL
Review: Compact & concisely informative, this is one of my best purchases. The book lives in the car for ready reference & gets so much use, the cover edges are wearing down

Rating:
Summary: your little trusted friend
Review: During my practice whenever I needed to consult it, it gave me information about the symptoms and diseases. The contents are so tightly packed to reduce its volume that one feels it might not be having the required details but it does. Sometime one feels short of some diagrams or illustrations but even then it is very good.

Rating:
Summary: the basic library of a doctor
Review: I feel that this book is one of my best purchases. For any busy doctor, it is going to be one of the reliable sources of information for a diagnosis and hence the effective treatment plan. I am a homoeopath but use it before consulting my repertory and materia medica.

Rating:
Summary: Good depending on what you need/know
Review: This book is really good if you have an adequate background in physical examination. It is an excellent book for the upper year medical student and beyond. But may be too complex for the beginner. I use it as a major supplement to Bates.

Rating:
Summary: A tour de force
Review: This book is the eight edition of a venerable work first written in 1965 by the great Elmer DeGowin, MD. Dr. DeGowin was a professor of medicine at the University of Iowa, and contributed immensely to research in transfusion medicine. Perhaps because of this, he is commonly remembered today as a hematologist, but this specialist designation, while recognizing his obvious expertise in this area of medicine, does not do justice to Dr. DeGowin's eclectic interest in migraine, trauma, thyroid disorders and many other areas of internal medicine. He was in his time the broadly trained master clinician.

This work may be seen as the culmination of his efforts as an educator of medical students in the profoundly important (and currently woefully neglected) area of clinical diagnosis. When Elmer died in 1980, the task of periodically bringing the book up to date fell to his son Richard Louis DeGowin, also of UI, up until the seventh edition published in 2000. With RL DeGowin himself now emeritus professor, editorship of the text for this newest 8th edition are in the capable hands of Richard LeBlond and Don Brown, professors of medicine at UI.

The work's subtitle is an accurate description of its aims: a "complete guide to assessment, examination, and differential diagnosis". One of the few textbooks of bedside clinical diagnosis produced in handbook format, it should nevertheless not be presumed to be incomplete - it is 1077 pages long! (An example of what an excellent publishing effort can do with medical handbooks - produce a thorough, exhaustive compendium in a size that will fit into a coat pocket). This apparent (and welcome) paradox - so much information written and produced so well that it is the size of a handbook - is not the only noteworthy feature of this work.

There are 18 chapters. Three introductory chapters on the diagnostic examination, the history and medical record, and an outline screening examination are followed by the main body of the work, focused chapters on the examination of all anatomic regions. Two final chapters explain the principles of diagnostic testing and adduce examples of common laboratory tests. There is a valuable chapter on the pre-operative assessment of a patient.

The real gem here however is the heart of the book - the detailed chapters on the examination of all the organ systems. In an age when the beauty, elegance, and sheer value of the clinical examination is increasingly underappreciated, DeGowin's is an affirmation of its central importance. In it you will not learn simply that there are such things as, for example, heart sounds and murmurs. You will learn what precisely they are, their semiophysiology, their meaning, what happens to them in disease. Knowledge, especially when disseminated by an erudite teacher, is inspiring. You will be inspired not to inanely parrot "S1, S2 present, no S3, S4, murmur"; rather you will seek out the gallop, or the Bruit de Canon, or perhaps even the Bruit de Diable. Splits, reversed splits, snaps, pericardial knocks, Austin Flint murmurs, pulsus tardus et parvus, pulsus paradoxus, alternans... they are all here, taught patiently, explained clearly. Many of the beautiful figures were inked first by Elmer DeGowin, in simple line diagrams, 40 years ago. They do much to make things clearer.

To given an example of the depth of the text, consider the subtopics in one subsection: heart murmurs. This is classified into systolic and diastolic, after the usual fashion. With respect to systolic murmurs, DeGowin explains the following: under basal systolic murmurs, we have aortic stenosis, supravalvular AS, Idiopathic Hypertrophic Subaortic Stenosis, pulmonic stenosis, infundibular PS, ASD at the ostium secundum, ASD from persisten ostium primum, coarctation of aorta, thoracic outlet bruit, HTN/atherosclerotic; under midprecordial systolic murmurs, VSD and tricuspid insufficiency; under apical systolic murmurs, mitral insuff and mitral valve prolapse; and under abrupt systolic murmurs, rupture of interventricular septum, papillary muscle or chordae tendinae. EACH of these is explained in two parts: the pathophysiology, and the clinical features of the murmur and associated findings. This is not a mere book of lists.

The breadth is as excellent as the depth. Every type of physical examination you can think of is represented; the skin, lymphatics, the endocrine system, the head and neck, breasts, genitals, lungs, heart, vessels, liver, spleen, kidneys, musculoskeletal, neurological, even the fingernails... all explained in devoted detail.

The new editor has done a first-rate job and tightened up some of the chapters, reorganizing material to make it easier to find topics. The one thing people used to complain about with DeGowin's was that while it was comprehensive, the organization made it difficult to use. This is no longer a problem, and the excellent use of color type and varying fonts is a plus. Each chapter is organized in a uniform fashion: first, an overview of the system under consideration, then superficial and deep anatomy, third the method of examination, fourth the symptom-complexes the patient may present with, fifth the physical signs that may be elicited, and finally syndromes. These final sections in each chapter have explanations of pathophysiology, followed by extensive differentials. The book is thoroughly cross-referenced.

A common "justification" for the indifference many residents and medical students display toward thorough clinical exams is that signs aren't common these days, so we might as well not read about them or seek them. I think this is not true. How well an examination is conducted is a function of knowledge, skill and motivation. When there is no knowledge of methods and signs, they will simply not be elicited. Even a medical student, properly taught and motivated, can do an excellent job at diagnosis. In my final year of med school, after I had placed an enormous effort into learning and practising bedside diagnosis, I remember repeatedly coming up with diagnoses and findings others (much senior to me) had missed. This was only because I would actively look for them (and I knew about them), not because of anything special.

DeGowin's Diagnostic Examination is a masterpiece, one of the two greatest American works on clinical diagnosis in the last half- century. Every medical student worth the name should read it, and ponder its wisdom.