Miller's Anesthesia 7th - opinion?

[itokama]

How do you like this book?

I am studying from it now... Some chapters I really like (for instance the ch. on PONV). But in some of them there are mistakes, the authors misquote articles...

Just wondering how others who use it, feel about this book... 😕

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[Yo GabbaPentin]

I feel that it probably big, heavy and unnecessary.

Do not read this book hoping to retain lots of info and pass your boards. Only read this from front to back out of dorky love for anesthesia. Repetition is key to passing your boards. Obsession to the point of reading this book cover to cover will interfere with your social/love life.

Sell it on amazon and use your programs copy.

 

[Gern Blansten]

How do you like this book?

I am studying from it now... Some chapters I really like (for instance the ch. on PONV). But in some of them there are mistakes, the authors misquote articles...

Just wondering how others who use it, feel about this book... 😕

Two options:

If you know anesthesiology well enough as a resident that you can read and find mistakes in the Miller text, you are very bright and probably don't need the Miller text.
or
You are misguided and don't realize that you are wrong and the text is correct, in which case, you may be the argumentative type who could be very bright, but will struggle on the oral boards if you come across as thinking you know more than the examiners.

I don't know you or the mistakes you speak of in the text. So, I have no idea which one of the above might be true. I have the text, but only use it as a reference. I have only read small portions of it. What I have read appeared to be well done and I liked it as a reference.

 

[beavis]

I feel that it probably big, heavy and unnecessary.

Do not read this book hoping to retain lots of info and pass your boards. Only read this from front to back out of dorky love for anesthesia. Repetition is key to passing your boards. Obsession to the point of reading this book cover to cover will interfere with your social/love life.

Sell it on amazon and use your programs copy.

I think Miller is a great study source. Reading each chapter while going through corresponding rotations as a resident was very beneficial.

Granted, for ITE/boards a concise review book is worthwhile.

No comment on my social/love life.

BEAVIS

 

[Pooh & Annie]

I thought the chapters varied quite a bit in their usefulness. Overall I'm not a huge fan.

 

[aredoubleyou]

Two options:

If you know anesthesiology well enough as a resident that you can read and find mistakes in the Miller text, you are very bright and probably don't need the Miller text.
or
You are misguided and don't realize that you are wrong and the text is correct, in which case, you may be the argumentative type who could be very bright, but will struggle on the oral boards if you come across as thinking you know more than the examiners.

I don't know you or the mistakes you speak of in the text. So, I have no idea which one of the above might be true. I have the text, but only use it as a reference. I have only read small portions of it. What I have read appeared to be well done and I liked it as a reference.

All textbooks are filled with dogma, based on small studies, retrospective and case series, etc. as the reader, especially people newer to the profession or who don't regularly read, you don't know the quality of evidence to support each assertion. Miller is full of half truths and some chapters are simply written better than others. It is not difficult to find examples of this....the problem is the "truth" that one is comparing it to is also an incomplete story as well.

 

[cchoukal]

All textbooks are filled with dogma, based on small studies, retrospective and case series, etc. as the reader, especially people newer to the profession or who don't regularly read, you don't know the quality of evidence to support each assertion. Miller is full of half truths and some chapters are simply written better than others. It is not difficult to find examples of this....the problem is the "truth" that one is comparing it to is also an incomplete story as well.

This is kind of a silly generalization, and the assertion assumes that there might be some better level of evidence out there than what the textbook authors are able to find. The reality is that not every concept in a textbook has been subject to the rigors of a randomized controlled trial; that's just the way it is. I didn't write for the 7th edition, but I did for the 8th, and I can tell you that we do the best we can with the evidence that exists. Sometimes the best evidence IS a case series, but it's not like we're misrepresenting that as "truth," (I hope).

Remember, too, that the evidence, even that from the gold standard RCTs, is subject the biases created by whatever outcome variable was selected and whoever paid for the study. The "truth" that we seek, as you point out, is a moving target. The best the textbook can do is present a summary of the best data available mixed, where appropriate, with the expert opinion of the author (many chapters are written by people who publish in that area), and an extensive reference list so you can go to the primary literature and decide for yourself.

I think one area where all textbooks fail is in the currency, searchability, and fluidity that is found in online resources. Wiki, with all its links and cross-references, is a great format. I'm not sure that a big bundle of printed pages represents the future of education or reference. Imagine incorporating full-color photos, links to videos of various techniques, links to NYSORA videos in the regional chapter, hyperlinks from the reference section to PDFs of the primary articles, etc. That would be a rich text, indeed.

 

[aredoubleyou]

and I can tell you that we do the best we can with the evidence that exists. Sometimes the best evidence IS a case series, but it's not like we're misrepresenting that as "truth," .

I think we agree more than disagree. My point is essentially that a reader, especially one new to the field, assumes that things published in a textbook (especially Miller, Harrison's, etc) is absolute fact. When one sees something in the anesthesia bible that is" inaccurate" it does not necessarily mean it was an error. The error could be that both "truths" do not have enough evidence to be accurate (what I would call a half truth). It is my silly belief that the majority of things that we often unquestionably hold as established fact, have far less evidence to back it up than many residents (and attendings) believe. This could be from cerebral autoregulation, lma & gerd, ketamine & intracranial pressure...even look at the new sepsis guidelines with cvp & procalcitonin. If you looked at a figure in a text book you might actually think they have the same validity as early antibiotics, for example. Another textbook leaves this out, the novice reader might think the author that left out cvp & procalcitonin was "made a mistake." I am not suggesting in any way that the author should take pages and paragraphs to sort this out - I just get amazed how people want to discredit other sources simply because it says something different in Miller Anesthesia.