Poll: Would you purchase this book?

I am in the midst of completing a book aimed at 2nd, 3rd, and 4th year medical students. Its basis is this:

It will act as your perfect "pimp protector." When you are asked by your intern or resident to:
A) Write a progress note on a patient with X disease
B) Go to the ER to admit a patient for your resident
C) Answer a commonly asked "pimp question"

the book will be ALL YOU EVER NEED. It will have the basic information on a disease process (Pulmonary Embolism), the pertinent positives/negatives you need to ask the patient (previous DVT, recent surgery, recent travel, leg pain, leg swelling), as well as the pertinent physical exam findings you need to document. It also has a list of labs you should order, and the appropriate management. Each topic will also have a "Pearls" section that will gear you towards most commonly asked "Pimp" Questions. And finally, each topic (when appropriate) will have a literature citation, to allow you to show you know your "evidenced based medicine." As in, "The PIOPED study showed the V/Q scan can reliably rule out PE IF it is read as normal, however even low probability scans carry an X% of PE."

What do you think? Would you buy it?

Q, DO

Originally posted by Aaron Earles
I would buy it.

Click to expand...

Cool! I am currently contacting publishing companies. I will let all of SDN know when it is complete! This book should be pretty useful for those studying for boards as well....

Q, DO

Originally posted by Kalel
How much would it cost? My experience with these pocket books is that it's a trade-off between not being comprehensive enough (missing common diseases) and not being able to fit in your white coat pocket. I will carry the Washington Manual or Ferri's Guide to medical management in my white coat sometimes, but both of those books are frustrating to carry around because they are so heavy and they don't even discuss a lot of common diseases (I don't remember which ones off the top of my head, I just remember that there have been many times when I have looked stuff up in the index and there wasn't even a section on what I want to read about). Anyways, if it's concisively but comprehensively written (ie light-weight with every common disease) and at a decent price, I'd be interested in purchasing it. I haven't been able to find a book that's met that criteria yet though.

Click to expand...

The cost wouldn't be up to me, but likely the publisher. I dont' expect it to cost more than (guessing here) $10-15. My book is a good bridge of all texts, but is geared more towards the 2nd-4th year medical student. I will post an example now:

Syncope
Syncope is the sudden transient loss of consciousness, that results in the inability to maintain postural tone, usually resolving spontaneously. Near-syncope should be evaluated as syncope. Syncope results from decreased cerebral perfusion from any number of etiologies, but the most important to consider are vasovagal, orthostatic, cardiac, and neurologic. The differential diagnosis should include cardiomyopathy, myocardial infarction, myocardial ischemia, aortic dissection, PE, cardiac arrhythmia, medications, vasovagal, orthostatic hypotension, TIA/CVA, and psychiatric.
Pertinent Positives/Negatives: Detailed history of events preceding syncope (circumstances, positioning, activity, emotions), associated symptoms with syncope, nausea, palpitations, chest pain, dyspnea, back pain, abdominal pain, diaphoresis, headache, neurologic weakness, diplopia, dysarthria, ETOH use, drug use (caffeine, amphetamines), Hx of cardiac/neurologic disease (esp seizures), FamHx of syncope/sudden death, medication use (hypertensive medications, antiarrhythmics), social situations (stressors, lack of sleep), single-car MVA?, straining/coughing/defecating at time of syncope, previous Hx of syncope/lightheadedness, does patient remember hitting the ground, duration of presyncopal symptoms, facial/oral trauma, urination/defecation upon awakening, length of LOC. Ask witnesses: convulsions, complaints before syncope, automatisms, focality, postictal state/confusion.
PE: Hypo/hypertensive, tachy/bradycardic, febrile, AMS, evidence of trauma to face/scalp/extremities (no defensive injuries to hands/knees, lacerations to tongue), BP measurements in both arms, palpable abdominal pulsatile mass, orthostatic BP, cardiac murmur, S3, S4, JVD, irregular rhythm, evidence of CHF, mental status, carotid bruits, motor/sensory deficits, rectal exam with hemoccult.
Labs: EKG, Accucheck, CBC, CMP, UDS, cardiac enzymes, consider CXR, ABG, Head CT, Carotid massage, echocardiography.
Management: Consider patient?s etiology of syncope, if the patient is at high risk for cardiac etiology (45 yrs+, hx of ventricular dysrhythmias, hx of CHF, abnormal EKG), the patient should have a further evaluation. Young patient with syncope, benign physical exam, and normal EKG can be discharged safely with follow up, and has a very low risk of morbidity.
Pearls: Vertigo and dizziness are not considered near-syncope. Up to 13% of patients with acute PE develop syncope. History and physical are by far the most important part of the syncope evaluation, and a diagnosis can be achieved in up to 80% with H&P alone. The postictal state is uncommon with syncope, and if present, lasts less than 30 seconds. Lacerations on the lateral side of the tongue are almost 100% sensitive for seizures, not syncope. Orthostatic BP measurements = Decrease in Systolic 20 mmHg or Increase in HR of 20, mention if patient symptomatic during measurement.
Literature: A 2002 NEJM article reports that patients diagnosed with vasovagal syncope have a benign prognosis, whereas those with cardiac syncope are at increased risk of death from any causes as well as cardiac death. Soteriades ES - N Engl J Med - 19-SEP-2002; 347(12): 878-85 (incidence and prognosis of syncope)


Q, DO

It looks a little cluttered, but each section is differentiated by each other by a space and a bolded title. This is just one out of >130 topics.

My biggest fear as a medical student was to be sent down to the ER to "write the H&P and orders for that guy with a SBO/pneumonia/X." I would be able to get the basic stuff down, but would often forget to ask the seizure patient the last time they took their medications, or the last time they had a CT head, or... well, any of the hundreds of questions a medical student was supposed to ask a patient, but forgot. This book is perfect as you can read it in the elevator on your way up/down to wherever you need to be... read what you need in two minutes and be able to diagnose and answer most questions on that disorder. This book does NOT go in-depth into treatments, but does cover basics (Seizure - ABCs, benzodiazepines, barbiturates if necessary, consider intubation... etc).

The big thign I wanted as a student was a text the size of the pocket pharmacopeias, that had what I needed as a medical student, but didnt' go into crazy long calculations or talk endlessly about sensitivies and specificities.

Q, DO

Originally posted by Kalel
I agree with the purpose of your book, it would be nice to have a quick reference to use to make sure that you are asking all of the pertinent questions. Patients do tend to get annoyed if you disappear, then have to wake them back up later because you forgot to ask them something that you know the attending would like to know. I'd watch out for errors though; having an attending or another resident proofread your book may be nice. Is having a laceration on your tongue really 100% sensitive for having a syncopal episode secondary to seizure?

Click to expand...

We had one of the top neurologists in the state lecture to us, and he said that "almost 100%, if you see a tongue laceration, you can be almost CERTAIN the patient had a grand mal seizure." I didn't mean to confuse grand mals with other types.

And I am having several of my attendings proofread my book, as well as over 20 residents, students, and attendings add "pearls" and "pimp answers."

Q, DO

Ack! I stand corrected! It shoudl be specific not sensitive. Thakns for pointing that out. (Fear not, the book will have been read by several attendings before its printed!).

Dr. Mattu teaches you well, Kalel.

Q, DO

Originally posted by DrMaryC
I would buy it b/c I trust your expertise. I haven't bought any pocket references yet. There are so many out there. But you've talked about it here in the forums and so forth, so yes. I'd buy it. Good marketing!

Click to expand...

That's very kind of you!

The reason why I decided to undertake this book (its taken me 5 months) is because when I was on my rotations in the ER (as an intern), it became obvious to me that medical students knew the basic stuff about the disease process, but often didn't know what to ask in the H&P or HPI. I posed the question "Why is it important to look at the legs of someone dyspneic?" Then the students would remember "oh yeah, you can have either pretibial edema or erythema/swelling." It would trigger their memory!

How many times as a student were you kind of "lost" when someone said "Go take a history on Mr. X with chest pain." You could get the basic stuff... but would you always remember to actually LOOK for a great saphenous vein scar, or to ask the last time they had a cardiac catheterization? That's what this book is about. To job your memory and to remind you what you need to ask, so you A) Look like you know what you're doing, B) Take better care of the patient, C) Perhaps be able to defend off a few pimp questions, and D) With the NEW, UNHEARD OF citation section, where you can tell your resident "The PIOPED study shows that V/Q scan can reliably rule out a PE if read as normal." (However, V/Q scans are rarely read as normal), but the fact is you quoted a study in the right context!

Q, DO

Thanks for all the comments. Any others?

Q, DO

Not sure yet. I'm submitting it to the publisher within a week or so. Should hear back in 3-4 weeks for revisions and if all goes well a time will be given then! I'll keep all updated.

The majority of the book is finished, i am just having some attendings review it for completeness and their input (even as an intern, I'll present a patietn adn they'll ask me if I asked something, which I didn't... so I am getting their input too).

Q, DO

Originally posted by JKDMed
Do you think publishers would have a problem with you being a DO? I'm not trying to imply anything, but if I was a publisher I would be worried about poor sales because of you being a DO. Many people might would see the author is a DO and simply assume you have nothing to offer and pass your book up.

Have any publishers made a deal out of this?

Click to expand...

I doubt it. The two co-authors/contirbuting authors are MDs at my program and have done oodles of research.

And I actually have three publishing companies very interested in the book (one big name one). I will be submitting my book proposal this week.

Q, DO

I dont' think it matters. If you really looked at authors, you'd probably see a surprisingly disproportionate # of DOs that write this sort of thing.

Q, DO

The book is different in that it is aimed at medical students. When was the last time you needed to give the dosing for heparin in ACS or PE? A medical student does not need to know that minutiae.

This book gives you what you need to know, when you need to know it. Say its your first day on OB/GYN and you're told to round on a post partum patient, or to evaluate a patietn for pre-eclampsia. Sure, you might know the basics about pre-eclampsia, but would you remember to check a serum uric acid level? Or in chest pain would you always remember to ask about cocaine use?

As medical students, you know the basics. But hasn't everyone been in the spot where your resident/attending asked you a question about your patient that you forgot to ask? And how about those pimp questions everyone gets asked on the wards. Does serum ammonia levels correlate with encephalopathy? What ARE the most common EKG findings in PE?

This book is aimed for anyone who needs to refresh on a certain topic before they see the patient or present to their attending.

Also, this book will include a "landmark" literature citation for each topic (and paraphrased for easy understanding), so you can learn evidenced based medicine and quote it... intelligently!

Q, DO