Oxford Textbook of Medicine 2nd Edition
Editors :J. Grimley Evans, T. Franklin Williams, R. Lynn Beattie, J-P. Michel, G.K. Wilcock
Oxford University Press, Toronto, 2000
Reviewed by: Shabbir M.H. Alibhai, MD, FRCP(C)
Geriatric textbooks come in several varieties. Some focus on specific content areas and are both comprehensive and detailed. Others cover pertinent areas of geriatrics in a portable overview fashion. A third group--which includes the Oxford Textbook of Medicine--is comprised of stand-alone reference texts that combine the best of both broad-based coverage and comprehensiveness, bringing together the art and science of medicine in one heavy tome. This is an onerous task in which the Oxford Textbook of Medicine succeeds well in some areas but not so well in others.
As the focus of my review of this large volume (over 1,200 pages), I chose, in addition to doing a general overview of the 27 sections of this guide, to examine several subject areas. These areas are representative of well-known evidence-based areas of geriatrics (anticoagulation in atrial fibrillation), of emerging fields that show some level I evidence but that lack in consensus (cognitive enhancing therapy in dementia) and finally, of topics that elicit much opinion, but which are based on little data (pharmacological treatment of delirium).
To begin with, this reference is written by numerous distinguished contributors from various fields of clinical geriatrics and gerontology, basic science, ethics, and research. The editors and authors are an internationally diverse group that brings together ideas in modern geriatrics from several continents. The text and tables are nicely formatted and easy to read, although the almost absolute lack of colour, and limited illustrations, make it visually challenging at times. There are very few annoying typographical errors. Chapters are organized logically, although in the organ-based medicine sections it would have been nice to have, consistently, an introductory chapter on the physiology of aging of each organ system. The index is also easy to use although a bit sparse at times (e.g. B12 is only listed under cobalamin and vitamin B12, not B12).
In its capacity as a comprehensive overview of geriatrics, this textbook does well in offering the reader some nice chapters about the demographics of aging, and about aging in developing countries. There is welcome coverage of a number of other miscellaneous topics like the concepts of frailty and "failure to thrive", and the roles of geriatric day hospitals and stroke units. Unfortunately, some topics (e.g., fecal incontinence) which are not well covered in traditional texts and review articles, are covered sparsely in this book as well. From my own perspective, the very thin chapter on cancer and aging is embarrassing. The section on ethics mentions nothing about religiosity and the impact of traditional beliefs on many patients' and caregivers' ethical positions with respect to their medical treatment.
In terms of evidence-based medicine, the offerings vary in quality. The editors have tried very hard to cover the subject matter succinctly, but numerous times throughout the book the material ends up being too terse. The anticoagulation literature in chronic atrial fibrillation, for example, is summarized well in text and tabular form, but a short paragraph on paroxysmal atrial fibrillation management gives questionable recommendations with no references to any literature. Several pivotal cardiovascular and diabetic clinical trials are not mentioned at all, and the controversies regarding the estimation of creatinine clearance in the elderly are largely ignored. Despite the completion of over twenty large randomized trials testing cognitive enhancing therapy in dementia, only a few paragraphs struggle to summarize this challenging body of information. Conversely, in delirium management, the writer justly discusses the limited amount of evidence which exists to guide treatment and goes on to offer what amount to some clinical management pearls given the paucity of controlled trials.
Two final points deserve mention: First, there are many sections where practical flow-charts or algorithms could have been added which would have aided clinical decision-making and clarified the subject matter. Second, there is a nice little collection of paper instruments and scales in the useful information chapter, although it would have been nice to get a standardized guide to scoring the Folstein MMSE along with the actual instrument.
At the end of the day, there is enough information from a tremendous variety of sources and experts in this volume to make it a welcome addition to the library of a physician with a strong interest in geriatrics. However, it needs to be spruced up to compete with more sophisticated electronic/ online offerings and to appeal to physicians looking for better and clearer science. A good book, but temper your expectations.
