Book Reviews   |    
Musculoskeletal Medicine
Richard A. Deyo, MD, MPH1
1 University of Washington, School of Medicine Seattle, Washington
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Joseph Bernstein, editor. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 2003. 494 pages. $85.00.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jun 01;86(6):1350-1350
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


This new book has a pleasing breadth and depth of information that seems best targeted toward medical students and residents. About a fourth of the book is devoted to a discussion of musculoskeletal biology and anatomy, and these presentations are quite clear. The remainder of the book is devoted to the pathophysiology, diagnosis, and treatment of common musculoskeletal disorders.There are many things to like about the book: the writing is clear and many of the illustrations are excellent, especially some particularly clear anatomical drawings. A very useful section on physical examination extends for some sixty pages and contains excellent photographs that illustrate common maneuvers.
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    Richard A. Deyo
    Posted on August 24, 2004
    Dr. Deyo responds to Dr. Levine
    University of Washington

    To the editor:

    In response to Dr. Levine’s concerns, I am happy to reiterate and amplify my statement that “Musculoskeletal Medicine” can be recommended to medical students and residents. I certainly understand the constraints of space, format, and readability. Most of the readership of JBJS is not comprised of medical students or residents, so it seemed important in the review to offer caveats for the general reader. I also had the impression that “Musculoskeletal Medicine” was intended in part for primary care physicians, and hence my comments in that direction.

    Intended audience aside, I think it is time for all of us in medical education to bring more emphasis to the principles of evidence-based medicine. Once we move beyond the realm of anatomy and physiology into diagnosis and therapy, these principles become paramount. Just how accurate is a diagnostic test in comparison to some “gold standard”? What is the clinical evidence that a treatment is more effective than placebo (or alternate treatments), beyond a physiologic rationale?

    It seems important to expose to our trainees the quality of clinical evidence and ambiguities in our knowledge, lest they believe medical knowledge is more monolithic than it is. Even for a trainee audience, I might have hoped for more emphasis on these principles.

    Richard A. Deyo MD, MPH

    Alan M. Levine, M.D.
    Posted on August 20, 2004
    Musculoskeletal Medicine--book review
    Director, Cancer Institute, Sinai Hospital, 2401 W. Belvedere Ave., Baltimore, MD 21215

    To the Editor:

    As chairman of the Publications Committee of the AAOS, I was pleased to see a review for our book, Musculoskeletal Medicine. I was further pleased to see that the reviewer noted the book's "pleasing breadth and depth of information", and cited its clear writing, excellent illustrations, and very useful section on physical examination.

    It was disappointing, however, to read of the reviewer's complaint that the book may frustrate primary care physicians or specialists. In Dr. Bernstein's preface it was clearly stated that "Musculoskeletal Medicine is a book for students" written because "nearly half of American medical schools did not require a course in musculoskeletal medicine." Students often acquire information on musculoskeletal conditions in a piecemeal fashion on a variety of rotations. As the preface clearly states, this book was conceived as an overview providing an organizational structure "to help place concurrent observations, readings, and clinical experiences in perspective. It aims to serve as a springboard to further study and application. There are gaps in this book, no doubt, but they are unavoidable. To make things manageable, some detail had to be sacrificed."

    The AAOS has published a book for primary care physicians-the well received Essentials of Musculoskeletal Care, now in its second edition-and of course, many, many books for specialists. I am pleased that the reviewer ended by stating that "this book can be recommended to medical students and residents as an excellent introduction to musculoskeletal medicine." But such a disproportionate amount of the reviewer's critique was dedicated to listing the book's failings as a "best reference text for primary-care practitioners" that I am afraid that overall positive recommendation for students might be drowned out.

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