McMaster Textbook of Internal Medicine : A Review
Vol 9 #2
James Alan Bourgeois, O.D., M.D.
Chair, Department of Psychiatry,
Baylor Scott & White Health, Central Texas Division
Clinical Professor for Medical Education, College of Medicine,
Texas A&M University Health Science Center
The McMaster Textbook of Internal Medicine (Editors in Chief Roman Jaeschke, Piotr Gajewski, & Paul O’Byrne) is a highly innovative, topical, and modern approach to a clinical medical textbook. It is both a volume, and perhaps more critically, a concept, whose time has come. Available in both continuously updated on-line and once-a-year printed format, it will quickly establish itself as among the best quickly available and “portable” general medical texts. It is of equal value to practicing physicians, residents, medical students, and other groups in the health professions.
The Textbook was developed at McMaster University, with primarily McMaster medical faculty plus others from other academic medical centers. True to the proud legacy of McMaster being the home of evidence-based medicine, the Textbook features recent literature to guide clinical diagnosis and decision making, with an emphasis on the practical, not the esoteric, and presenting clinically relevant material organized around the ways that patients actually present in the medical setting. Rare and clinically esoteric topics are not addressed in detail, thankfully, as the Editors emphasize standardized and thoughtfully organized clinical interventions reflecting the recent clinical literature.
Clinical topics are primarily classified by the relevant medical clinical specialty. Psychiatry is given its own discrete section. I am particularly grateful that the regrettable collective terms such as “mental health disorders” and “behavioral health conditions” are eschewed for the academically, intellectually, and conceptually preferred term “psychiatry.” The psychiatry section accomplishes two interdigitating functions: it is a cogent, diagnostically clear and current resource for other specialty physicians, and is a concise summary guide for the psychiatrist in managing psychiatric illness in the medical setting.
The Editors for the Psychiatry Section are Rebecca Anglin, Ana Hategan, Nick Kates, and Robert Zipursky. Within the Psychiatry Section, there are transdiagnostic topics (e.g., the agitated patient) as well as specific diagnostic headings (e.g., delirium). Mixing topic types can be perilous in such a work; e.g., “agitation” can be covered redundantly in more than one area, and the initial place to seek advice might not be clear. Nonetheless, the Editors do an admirable job at focusing the clinical content to the topic area.
The Section Editors, perhaps anticipating such challenges, have engineered the topics to minimize such areas of imprecision. Each topic stands alone as a concise, yet clinically thorough, treatment of the clinical area, while the style is such that the topic areas resemble each other in depth and readability. The Section Editors thoughtfully include Medical Care of the Serious Mentally Ill and Medical Practice and the Law (with specific pertinent details for psychiatric practice), which are topics usually not addressed in sources such as this.
The Psychiatry section makes liberal use of tables to classify clinical information and to aid clinical decision-making. The inclusion of a Physician Health and Wellness section is particularly welcome, given the pressures on physicians worldwide and the need to self-care in an ongoing way. A comprehensive Toxicology section addresses several topics of psychiatric relevance, such an anticholinergic and lithium toxicity states.
In the Acute and Critical Medical Care section, there is an excellent presentation on psychiatric examination, with the assertion that “The purpose of this chapter is to provide a framework for the non-psychiatrist physician to collect a thoughtful and thorough psychiatric history and conduct a mental status examination.” Indeed, this section fractionates the mental status examination in a logical sequence that is clear, cogent, and appropriately thorough, without becoming excessive or “exhaustive.” The fact that the Editors in Chief included this section along with other general medical evaluations properly positions psychiatric illness and psychiatry as a medical specialty commingled with other medical specialties and evaluative techniques.
This is a very well-written resource that puts psychiatric illness and psychiatric practice in their proper place among other specialty illnesses and practices. Physicians of all disciplines will find this resource enormously helpful. Given McMaster’s historical identification with evidence-based medicine, I am confident that future iterations of this important volume will address any topical updates as needed.
Acknowledgement: the author is a former faculty member at McMaster and continue to collaborate with McMaster faculty members on various academic endeavours.