Wednesday, April 10, 2013

Harrison's Principles of Internal Medicine 14th Edition

In single volume, hard cover form (ISBN 0070202915 ), the 14th edition of Harrison's Principles of Internal Medicine Copyright 1998 is a classic.  I really like the beginning of the Introduction..

 The practice of medicine combines both science and art.  The role of science in medicine is clear. Science-based technology is the foundation for the solution to many clinical problems; the dazzling advances in biochemical methodology and in biophysical imaging techniques that allow access to the remotest recesses of the body are the products of science.  So too are the therapeutic maneuvers that increasingly are a major part of clinical practice.  Yet skill in the most sophisticated application of laboratory technology and the use of the latest therapeutic modality alone does not make a good physician.
 The ability to extract from a mass of contradictory physical signs, and from the crowded computer printouts of laboratory data, those items that are of crucial clinical significance, to know in a difficult case to "treat" or to "watch", to determine when a clinical clue is worth pursuing or when to dismiss it as a "red herring," and to estimate in any given patient whether a proposed treatment entails a greater risk that the disease -  all are involved in the decisions decisions that the clinician, skilled in the practice of medicine, must make many times each day. This combination of of medical knowledge, intuition, and judgement defines the art of medicine.  It is as necessary to the practice of medicine  as is a sound scientific base. > The editors of the first edition of this book articulated what is expected of the physician in words that... still ring true.
No greater opportunity, responsibility or obligation can fall to the lot of a  human being than to become a physician. In the care of the suffering she needs the technical skill, scientific knowledge, and human understanding.  She who uses these with courage, with humility, and with wisdom will provide a unique service for her fellow human, and will build and enduring edifice of character for herself.  The physician should ask of her destiny no more than this; she should be content with no less.
Tact, sympathy and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions.  The patient is human, fearful, and hopeful, seeking relief, help and reassurance. To the physician, as to the anthropologist, nothing human is strange or repulsive. The misanthrope may become a smart diagnostician of organic disease, but can scarcely hope to succeed as a physician.  The true physician has a Shakespearean breadth of interest in the wise and the foolish, the proud and the humble, the stoic hero and the whining rogue.  The physician cares for people.
I found this book in the laundry room.  Paper versions are for sale online for almost nothing.

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