Diagnosis of Chest Pain [antikvár]

This book is the result of the failure of a medical meeting to take place. In 1983, Martin Grais and l helped plan a meeting on chest pain syndromes. We developed what we thought was an imaginative approach to presenting the clinical material, and although the conference never took place, the thinking that went into producing that ghost led me to this book. The primary focus of this book, as with the failed conference, is on diagnosis. Although our conference teaching plan was to present chest pain syndromes in an interesting and stimulating manner to family practitioners, internists, and medical subspecialists, we hoped alsó to touch medical students and house officers, because it was in these young people that we saw a void in clinical understanding and perceived a need to enhance their diagnostic skills. The history and physical examination, used with an appreciation of basic anatomy and physiology, must more than ever be the primary tools of the diagnostician. Only by mastering them can he make proper use of the increasingly available elaborate diagnostic techniques. First and foremost is the effective use of one's own senses. Pain in the chest has profound significance to the sufferer, and the anxiety it provokes leads him to seek explanations. The physician's role will most often be to give reassurance, but it must be based upon an adequate knowledge of the science of medicine. The patient will usually recognize the slipshod physician as an inadequate authority. The proper response to a chest pain syndrome takes thought and care and time. One of my medical mentors, Louis N. Katz, often enjoined his cardiovascular research fellows to throw away their stethoscopes because they were antiquated instruments. None of us did; we knew Louis didn't mean it. In fact, as the years went by and he and I grew closer, I became aware of his great respect for able clinicians. During a medical residency, Thomas A. Noble and I became good friends. Noble, who used to enjoy the dark hours, would awaken me at night from time to time. "Come on," he would say, "Let's go listen to heart murmurs." And protesting, I would jóin him, and we would listen to the hearts of remarkably forgiving patients in the quiet of the hospitál night. Louis Katz taught the importance of science as the proper groundwork to clinical practice, and Tom Noble understood that clinical skills come only with effort. At the risk of offending somé experts, let me clearly state that I have little use for problem lists, which can be created without any synthesis of the information available and are a poor substitute for clear thinking. Our medical charts are encumbered by lists and confusions. We should leave the generation of lists to the computers. I opt for a return to working diagnoses based on the information at hand. Of course, they will often prove wrong. But we must have working diagnoses for each patient's difficulties. Don't put your brain in concrete; by all