Language in Mind: An Introduction to Psycholinguistics

The benefits of a readily accessible clinical reference become immediately apparent to every medical student tasked with conducting pre-dawn patient rounds. Written and edited by faculty and students at the University of Toronto, the Essentials of Clinical Examination Handbook aims to provide health care professionals with a portable yet comprehensive guide to symptom-based patient interviewing, focused physical examination, and diagnostic assessment. At a weighty 640 pages, it is unlikely to find its way into many white coat pockets — an unfortunate fact given the clarity and utility of much of the information within. The first and largest section of the book comprises 17 chapters intended to direct history taking and physical examination across all organ systems, including specific advice for pediatric and geriatric patients, and is a clear highlight of the text. The majority of the chapters employ a similar format. Relevant anatomy is briefly introduced through illustrations, followed by frequent chief complaints for a given system. The reader is then guided through a symptom-focused exam, describing information that should be elicited from the patient during the medical history and proper technique of pertinent physical exam maneuvers. The clinical examination is presented in a clear, logical manner that will mirror the flow of a successful doctor-patient interview. Each chapter concludes with a discussion of potential follow-up tests and imaging and their applicability to a number of common clinical presentations. Interspersed throughout the text are “clinical pearls,” asides that range from must-not-miss constellations of symptoms to appropriate timelines for disease screening to simple admonitions (“Make sure fingernails are trimmed!,” p. 126). Less successful are the 10 “Essentials” chapters, which provide additional insights into clinical specialties, including endocrinology, emergency medicine, infectious disease, and oncology, as well as more general topics such as pharmacology, fluid repletion, and imaging modalities. Certain chapters (Essentials of Dermatology, notably) are useful guides to common symptoms that would not be out of place among earlier chapters, though the hand-drawn depictions of rashes will do little to inspire confidence in one’s ability to identify them on a patient. Too often, however, the information in these chapters is presented in a dense, table-based manner akin to study guides for USMLE Step 1, making it nearly impossible to integrate into a successful patient interaction. Finally, the three appendices to the text cover the basics of evidence-based practice and clinical epidemiology, frequently used drugs for a variety of clinical scenarios, and common laboratory values, respectively. Of these, the tables of lab results prove the most useful, providing normal ranges, critically elevated, or decreased levels, and notes on their significance in an easy to browse format. While its lack of depth may render Essentials of Clinical Examination less useful in a specialty practice, medical, nursing, and physician assistant students should find the practical history and physical exam guidance invaluable. As an introductory reference to primary-care patient encounters, the book is highly recommended.

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