Clinical Medicine
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Preface
There is great need for a textbook of clinical medicine for the use of medical students and practitioners, with due emphasis on the local conditions
. Several books are available which are popular among students and teachers
. All these books are highly informative and useful but emphasis is given to the conditions prevailing in their countries of origin. 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
. The book is designed to provide information on complete clinical examination, correlation of clinical findings with pathological processes and guidance to select investigations in a cost-effective manner
. This book is produced in two parts. Part I includes Clinical Examination and Investigations required for training in the general medical wards
. Part II contains other medical disciplines included in the undergraduate curriculum—Pediatrics, Geriatrics, Pregnancy, Dermatology, Leprology and Sexually Transmitted Diseases, Psychiatry, Ophthalmology, Ear, Nose and Throat, Examination of Oral Mucosa and Teeth, Community Medicine and Statistics and Information Technology
. All the sections have been thoroughly revised and modified depending on the development in the subject so as to provide up-to-date information to the learner. Several photographs have been .added to facilitate selfstudy by the student
Clinical Medicine
The book is intended also to cater the needs of undergraduates throughout their course, internship,
further clinical studies, preparation for postgraduate entrance examinations in internal medicine and
practitioners in India. The students of others systems of medicine and practitioners of alternate systems may
also find the interpretation of physical findings and planning of investigations useful. The sections on
Community Medicine and Statistics and Information Technology have been specially designed to help the
students to read and understand modern medical literature, interpret published material critically and plan
research at the basic level. The section on information technology is intended to make the reader aware of
modern developments in this field and to acquaint himself to the use of tools to get further information.
All the contributors, who are veteran teachers, have tried their utmost to bring out the book as a useful
companion for studying clinical medicine .
