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A jumbled assemblage of anecdotes, advice, and gripes that does manage to provide a (disordered) view of the process of diagnosing--a process that internist Gibbons admits he can't quite put into words. But he is entertaining as he talks around how to diagnose--with a variety of case histories that are anecdotal rather than instructive (we don't always know enough about the disease to follow him). And his views on recent trends demonstrate a salutary respect for patients' needs: defensive medicine occurs most often, he notes, in clinical settings where one-to-one relationships don't exist; second opinions are really just a safeguard for insurance carriers, not primarily for the benefit of patients. He does, however, have his pet peeves. In a chapter of advice on helping the doctor, he inveighs against three common, annoying, ""clever"" responses (to the question what-brings you-here-today, ""Taxi""; to what-made-you-decide-to-come-in, ""My wife""; to what's-the-problem, ""That's what I want you to tell me, Doc""). Other injunctions: for heaven's sake, put your gown on properly (the hole goes in the back); and don't stick your tongue out when the doctor looks at your throat, it gets in the way. But we don't always get the why and wherefore: ""An elevated phosphorus could be an overactive pituitary gland""--but so what, and why? With more background and explanation--on the model of Isadore Rosenfeld's The Complete Medical Exam (1978)--readers would be better able to assist their doctors in the diagnosing process. Still, despite the lecturing and the fuzziness, an interesting glimpse of how doctors go about their work.

Pub Date: Oct. 1st, 1980
Publisher: Saunders--dist. by Holt, Rinehart & Winston