Description
Clinical Medicine, 4th Edition
The present medical scenario in addition to many of the diseases caused by poor socio-economic conditions,
most of the diseases encountered in developed countries such as lifestyle-related diseases, diseases of advancing
age and diseases caused by tobacco and biomass fuel smoke, disturbance in family relationships, road accidents,
environmental changes, more migration to townships without adequate development of infrastructure; have
all constituted to a change in disease patterns and epidemiology leading to gross change in the prevalence
and pattern of diseases. There is considerable overall improvement in the financial, socioeconomic, educational
and infrastructural improvement, but still vast areas of the country are deficient in infrastructure, clinical
facilities and availability of appropriate modern medical care. Basic investigations such as simple laboratory
tests, X-rays, electrocardiography (ECG) and even ultrasound studies are available in even remote villages
and towns. There is a rapid proliferation of secondary care and tertiary care hospitals in the private sector,
which provide health care on payment. These are available only to a smaller section of society.
The concept of primary care physician, which dominated till the middle of the twentieth century has
given place to the era of specialists and highly skilled specialists, so that the first entrants into the medical
studies proceed towards postgraduation and further acquisition of skills. Their services are available only in
towns and cities, where most of the secondary and tertiary care private hospitals are located. The students
and young physicians joining the medical profession have to be aware of these facts and it is their bounden
duty to provide medical care to the less affluent masses too. This entails the proper acquisition of clinical
skills, which alone may be adequate to diagnose and manage the vast majority of diseases occurring in the
community. The doctor should use his discretion to plan the investigations which reduce cost and inconvenience
to the patient. It is absolutely essential that cost-effective investigations have to be planned. All these require
a thorough knowledge of the principles underlying clinical examination and the interpretation of investigations.
Moreover, at the present time, when many young doctors may have to practice in remote communities single
handed, many investigations have to be carried out by themselves, e.g. urine examination for glucose, acetone
and deposits, examination of feces for ova of worms, or examine a blood smear for malarial parasites. The
ECGs and skiagrams may have to be interpreted without help. To facilitate the establishment of such laboratory
tests and empower the doctor to interpret the abnormalities, this book gives practical details to perform such
simple tests. In the case of the more complicated tests, only the principles and interpretation of the findings
are given.
