On Call Surgery

Abstract

In a system where service provision and career training are simultaneously expected of junior doctors, pocket books and their PDA equivalents have become a luring investment option. A wide variety of texts exist, such as the Oxford Handbook, At a Glance and Made Easy series. The American market contains similar equivalents for the weary intern: Washington Manual, Recall, etc. With such an abundant range is there a need for yet another pocket book? The authors have aimed to create a text that ‘will lead practitioners of all levels through a safe and relevant evaluation of clinical on-call problems’. It not only addresses the classic conditions encountered in the on-call management of surgical patients (fluid status, pain control, abdominal pain), but also broader medical issues, for example, hypertension, dysrrhythmias, seizures, insomnia, and falls. This makes the publication highly relevant to foundation years and ST1 trainees, whose training ethos is one of mastering the fundamentals of medical practice across specialties. The text is accurate, brief yet comprehensive and clear. Furthermore, the 100-page appendix contains an extensive surgical drugs formulary and emergency cardiac care algorithms. The text is not laid out in the traditional didactic manner. Instead, the information is arranged in a realistic event sequence focused around commonly encountered clinical problems. Each topic starts with the first questions that need to be asked when receiving the ‘phone call’. These are designed to aid triage and establish a provisional diagnosis. This is followed by ‘elevator thoughts’, which aim to ascertain the aetiology of the problem and establish a differential diagnosis prior to seeing the patient. Finally, the ‘bedside’ questions are used to determine the diagnosis, interventions and management needed. Crucially, it first addresses the ‘major threat to life’ issues for each presenting complaint, assessing their degree of urgency. In addition, the information is delivered in full sentences and not in list form (unless strictly necessary) thereby adding clarity to the authors' message. Pocket books have a tendency to cover a similar range of topics as their larger ‘reference’ counterparts only in an abbreviated fashion that is neither concise nor enlightening. This is not the case with On Call Surgery. By limiting the number of topics they address, the authors have managed to deliver a very comprehensive text that is both academic and practically relevant. This is illustrated in the chapter on central venous lines, which describes not only the procedure per se but also its indications, contra-indications and precautions, anatomical landmarks and equipment lists. The text is accompanied by clear line diagrams and is complemented by a variety of useful tips and comments. In a similar way, the chapter on rashes and anaphylaxis not only deals with the basic management of these conditions but also takes time to differentiate the causes and manifestations of urticaria, maculopapular, vesicular and purpuric rashes as well as their relevance to the surgical patient. Where necessary, the authors use diagrams liberally to explain difficult concepts (e.g. chest drain suction apparatus and underwater seals). In addition, the clinical content is supported by the relevant physiology and anatomy background (e.g. the Henderson–Hasselbach equation in acid-base disorders), which greatly aids understanding. In contrast to other publications, the pharmaceutical management of each condition is not merely enumerated but is fully elaborated in clear tables including the doses and other relevant comments on administration and interaction. On reading the book, the junior doctor has the impression that the authors have taken him or her seriously. This is not a tool for getting the inexperienced out of sticky situations (though it does this too) but rather an attempt to educate and instil a logical system of anticipating and solving clinical problems in a rational, safe and common-sense manner. In summary, it represents a genuine and valuable addition to the market. It provides a rigorous system for dealing with on-call uncertainties that serves to reduce levels of anxiety on both sides of the doctor–patient relationship.