Hutchison's clinical methods : an integrated approach to clinical practice

2012·76.85 MB·English

by  Michael Glynn

Hutchison’s
Clinical
Methods
For Elsevier
Commissioning Editor: Laurence Hunter
Development Editor: Sheila Black
Project Manager: Joannah Duncan/Louisa Talbott
Designer: Stewart Larking
Illustration Manager: Merlyn Harvey
Illustrator: Amanda Williams
Twenty-third Edition
Hutchison’s
Clinical
Methods
An integrated approach to clinical practice
Edited by
Michael Glynn
MA MD FRCP FHEA

Consultant Physician and Gastroenterologist,
Barts and the London NHS Trust;
Honorary Senior Lecturer,
Barts and the London School of Medicine and Dentistry;
Director, North East Thames Foundation School,
London, UK
William M. Drake
DM FRCP

Consultant Physician, Barts and the London NHS Trust;
Professor of Clinical Endocrinology,
Barts and the London School of Medicine and Dentistry,
London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
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First edition 1897
Twenty-third edition 2012
ISBN 978-0-7020-4091-7
International ISBN 978-0-7020-4092-4
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A catalog record for this book is available from the Library of Congress
Notices
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SECTION 
v

Prefacetothetwenty-thirdedition
With each new edition of Hutchison, the ques- essentials of practice, the clinical teacher and the
tion arises as to its relevance to the contemporary clinical student must work as hard as ever to ensure
study and practice of medicine. Although updated that core clinical skills are taught, learned and prac-
with new clinical knowledge, and new priorities and tised skilfully and appropriately.
methods of investigation, the fundamentals of the Hutchison’s Clinical Methods emphasizes this
book have remained unchanged for many years. By approach to clinical medicine, being split into four
following the same basic pattern, past and current sections. The first describes overall patient assess-
editors hope to emphasize the overriding impor- ment, and the second assessment in particular situ-
tance of a thorough and systematic approach to ations. The third includes chapters on the core body
taking a history, examining a patient and formulating systems and the fourth covers clinical methods as
a differential diagnosis, which remains as essential as seen by the key clinical specialties. Overall this
ever to providing good patient care. forms a logical sequence if read straight through,
The complexity and fragmentation of many but also allows study of each section separately.
modern health systems, and the expectation of some The organization of the book still follows the
patients that ‘there is a test for every disease’, work aims set out by Hutchison with his colleague, Rainy,
counter to the application of a basic clinical method, in the first edition, published in 1897.
and also tend to lead clinicians towards incomplete The plan of this new edition continues to empha-
diagnosis and therefore the wrong management plan size that teaching the medical history and examina-
for their patients. In turn, this can lead to over- tion in isolation from the process of diagnosis and
investigation, inappropriate treatment and increased planning management is illogical and likely to lead
suffering for patients. For many patients, diagnosis to error. Therefore, each chapter describes both the
by history and examination alone is far preferable to process of history taking and examination, and how
the application of complex tests. This saves both the the information gained is integrated into the process
patient and doctor time, reduces the cost of tests, of diagnosis and planning of care, making the book
helps avoid the potential adverse consequences of an essential adjunct to a standard textbook of medi-
these tests and is universally applicable, both in cine, surgery or a specialty.
developed and less-developed areas of the world. As in all past editions of Hutchison, all the authors
Complex or expensive tests clearly have an increas- have existing or past links with ‘Barts and the
ing role in modern medical and surgical practice. London’, now consisting of The Royal London Hos-
They will often reveal new subtleties to old- pital, St Bartholomew’s Hospital and The London
established clinical methods, and their role must be Chest Hospital. The editors gratefully acknowledge
absorbed into clinical methodology. Every clinical the work of all the current authors, as well as previ-
test and investigation has its own relevance, and ous authors who have not contributed to this new
any test, whether simple and old-established, or a edition.
complex modern investigation, should be applied
only when it is likely to yield trustworthy informa- Michael Glynn and Will Drake
tion, and not in other circumstances. To learn these Royal London Hospital
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Sir Robert Hutchison MD FRCP

(1871-1960)
Clinical Methods began in 1897, three years after
Robert Hutchison was appointed Assistant Physician
to The London Hospital (named the Royal London
Hospital since its 250th anniversary in 1990). He
was appointed full physician to The London and
to the Hospital for Sick Children, Great Ormond
Street in 1900. He steered Clinical Methods through
no less than 13 editions, at first with the assistance
of Dr H. Rainy and then, from the 9th edition, pub-
lished in 1929, with the help of Dr Donald Hunter.
Although Hutchison retired from hospital practice
in 1934, he continued to direct new editions of the
book with Donald Hunter, and from 1949 with the
assistance also of Dr Richard Bomford. The 13th
edition, the first produced without Hutchison’s
guiding hand, was published in 1956 under the
direction of Donald Hunter and Richard Bomford.
Dr A. Stuart Mason and Dr Michael Swash joined
Richard Bomford on Donald Hunter’s retirement to
produce the 16th edition, published in 1975, and
following Richard Bomford’s retirement prepared
the 17th, 18th and 19th editions. Dr Swash edited
the 20th and 21st editions himself, and was joined
by Dr Michael Glynn for the 22nd edition. Each of
these editions was revised with the help of col-
leagues at The Royal London Hospital, in keeping
with the tradition that lies behind the book.
Sir Robert Hutchison died in 1960 in his 90th
year. It is evident from the memoirs of his contem-
poraries that he had a remarkable personality. Many
of his clinical sayings became, in their day, aphorisms
to be remembered and passed on to future genera-
tions of students. Of these, the best known is his
petition, written in 1953, his 82nd year:
‘From inability to let well alone;
from too much zeal for the new
and contempt for what is old;
from putting knowledge before wisdom, science
before art, and cleverness before common sense;
from treating patients as cases;
and from making the cure of the disease more
grievous than the endurance of the same, Good
Lord, deliver us.’
Michael Glynn and Will Drake
Royal London Hospital
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Contributors
F. Runa Ali BSc MBBS PhD FRCP Adam Feather FRCP(UK)
Consultant Physician in Respiratory Medicine Senior Lecturer in Medical Education and
and Allergy Honorary Consultant Geriatrician
Barts and the London NHS Trust Barts and the London School of Medicine
London, UK and Dentistry and Newham University Hospital
NHS Trust
Andrew Archbold MBBS MD FRCP London, UK
Consultant Cardiologist
Barts and the London NHS Trust Jayne Gallagher MBBS FRCA FFPMRCA
London, UK Consultant in Pain Medicine
Department of Anaesthesia and Pain Medicine
Rino Cerio BSc FRCP(Lon) FRCP(Edin) FRCPath Barts and the London NHS Trust
DipRCPath ICDPath London, UK
Director, Clinical Academic Unit
Cutaneous Medicine and Surgery Michael Glynn MA MD FRCP FHEA
Barts and the London NHS Trust Consultant Physician and Gastroenterologist
London, UK Barts and the London NHS Trust;
Honorary Senior Lecturer
Tahseen A. Chowdhury MD FRCP Barts and the London School of Medicine
Consultant Physician and Dentistry;
Department of Diabetes and Metabolism Director
Barts and the London NHS Trust North East Thames Foundation School
London, UK London, UK
Andrew Coombes BSc MBBS FRCOphth Robert Ghosh MBChB FRCP FFICM
Consultant Eye Surgeon and Lead Clinician Consultant Physician
for Ophthalmology Director of Intensive Care
Barts and the London NHS Trust; Director of Acute Medicine
Honorary Senior Lecturer Clinical Director of Critical and Urgent Care
Barts and the London School of Medicine Homerton University Hospital NHS Trust
and Dentistry London, UK
London, UK
Beng T. Goh MBBS FRCP FRCPI DipDerm DipVen
David P. D’Cruz MD FRCP Consultant Genitourinary Physician
Consultant Rheumatologist Department of Genitourinary Medicine
George Koukis Reader in Vascular Rheumatology Barts and the London NHS Trust
The Louise Coote Lupus Unit London, UK
Guy’s and St Thomas’ NHS Trust
London, UK John P. Monson MD FRCP FRCPI
Emeritus Professor of Clinical Endocrinology
William M. Drake DM FRCP Barts and the London School of Medicine;
Consultant Physician, Barts and the London Consultant Physician and Endocrinologist
NHS Trust; London Clinic Centre for Endocrinology
Professor of Clinical Endocrinology London, UK
Barts and the London School of Medicine
and Dentistry
London, UK