Thoughts for you bookworms about textbooks

May 2006

Another one of those zebra cases appeared in my office again. Scratching my poor-encephalic head, I could not remember (as if I ever knew in the first place) the differential diagnosis of the etiology of ongoing hot flashes in a teenaged girl.

I searched innumerable general pediatric textbooks in my office and the Internet by “Googling,” and still arrived at a blank slate. Strangely enough, the answer to my question was not in my pediatric textbooks, but in my Internal Medicine textbook.

This led me to ponder those textbooks or reference sources that are essential for the practice of general pediatrics. So I looked at my lengthy shelf of textbooks stacked in front of my office cubby space, which is quite extensive. But I must admit, if I were stranded on a desert island or sent to solo practice, the following references would be essential for my journey.

Remember though, as my partner James Hedrick, MD, proffered, “The most important reference source for the evaluation of strange or bizarre cases in our practice is my partners.” Strength does lie in numbers sometimes, even in medicine.

So these are the core textbooks I would recommend for inclusion in the library of every general pediatrician. I do realize there may be other valuable or well-done sources, but this is my opinion after 24 years of pediatric experience. I also do not need reminding of my fallibility.

They are listed in order of importance. Each of these has clear, concise text/organization, is authoritative and provides a thorough index of contents. I highly recommend purchasing the new editions of each as they are published. A minimalist might squeak by purchasing every other new edition. You should consider owning at least two of the resources in the general pediatrics and infectious disease sections.

General pediatrics

Nelson’s Textbook of Pediatrics by Behrman et al. (17th edition). Each office needs a broad-based textbook on general pediatrics. My vote still remains Nelson’s. As D. Epstein, MD, comments on Amazon.com, this textbook “is the gold standard.” All common pediatric topics are thoroughly reviewed. Almost any esoteric diagnosis encountered in general pediatrics is at least touched upon (with the exception of hot flashes). With the more expensive version, one also receives an e-version that provides updates, but you must have the CD-rom running in order to update, I am told.

Harriet Lane Handbook. (17th edition). When one needs to know the dose of non-FDA approved pediatric medicine, the normal values or name of an esoteric test, a quick source for the dermatomes, and the technique for a pediatric procedure — this little handbook is your “go-to” guy. The fluid and electrolyte section is often handy. For example, where else can you find for the resident the elusive normal values for the tricky serum porcelain level? The ancillary PDA version has thus far been cumbersome and very difficult to navigate.

Harrison’s Principles of Internal Medicine by Kaspar et al (6th Edition). Sorry crew, but you are not finished yet with this gospel for medical students. This book spans the entire gamut of medicine in biblical proportions. Even many pediatric diseases and conditions are discussed very well. And if you care for adolescents, I encourage including this text on your shelf, as the coverage of topics that I have personally encountered, such as hypertension, goiters/thyroid lumps, gout, testicular/colon cancer and other specific tumor sites is unsurpassed. Many of our pediatric problems span into the range of this textbook. We always bemuse in our office, “if you cannot find it in Harrison’s, then it does not exist.”

UpToDate.com (~$500, computer-based) This computer-based, full service resource on the entire gamut of medicine from pediatrics to internal medicine to gynecology, dispenses a quarterly updated wealth of information on most any topic one can encounter in pediatrics (except for hot flashes in teenagers). This is a very user-friendly source for the Internet savvy physician, and could supplant the need for a general pediatric and general medicine textbook. It features an easy search engine, but it does not relegate the findings to just pediatrics, which can lead one on futile searches. The program also provides a palm pilot or PDA version, a superb bonus if one is at the hospital or has a satellite office. However, it took me a month to get this installed on my brand new Dell Axiom. To install, one must have a new 2GB memory card, and a new memory card reader and probably a new, very fast (>400GHZ) PDA as well, and (I think) the BRAND NEW CD rom from Uptodate. Persistence and a lot of time with their friendly prompt tech support will pay off.

Epocrates (free download to your PDA). This is the pinnacle of a quick and simple-to-use pharmacology database of most available drugs. It provides most pediatric drug dosing, but only if FDA-approved, and usually provides the cost, packaging, and the profile of the most common adverse events.

Infectious diseases

Textbook of Pediatric Infectious Diseases by Feigin and Cherry ( 5th edition)

Principles and Practice of Pediatric Infectious Disease by Long et al. (2nd edition)

One of these two textbooks should be required for any general pediatrician, as we spend nearly one-quarter of our time in the office dealing with infectious diseases. Both of these infectious disease textbooks provide outstanding, “authoritative, exhaustive but concise, and easily the most readable text,” as noted by K. Ching on Amazon.com about the Long textbook. The Feigin textbook usually provides more in-depth information on the background issues such as epidemiology and taxonomy of particular organisms. In fact, both textbooks are so well written and provide different nuggets of information that I purchased both of them for our busy practice.

2003 Red Book Report on the Committee of Infectious Diseases (Red Book:AAP). This is the must-have source for the latest information on vaccines and management of the more common infectious diseases. It is the gospel on these matters.

Nelson’s Pocketbook of Pediatric Antimicrobials by Bradley and Nelson (new edition soon expected). This is an invaluable quick reference for the dosing of any pediatric antimicrobial. It is especially useful for dosing of newborns, larger children/teenagers and for particular infectious processes.

Dermatology

Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood And Adolescence by Paller et al (3rd edition). This book remains the ultimate resource for any challenging pediatric dermatologic condition, especially with this newest edition. It probably even has enough color photographs of most pediatric dermatologic conditions to make it the complete authority.

Congenital malformations

Smith’s Recognizable Patterns of Human Malformation by Jones et al (5th edition).

“Still the best resource on birth defects & syndromes, now in full color,” writes E. Abrahams on Amazon.com. It allows one to synthesize a constellation of dysmorphic findings into a syndrome, if there has been one reported. It provides all the associated features, prognosis, and photos of the multitude of reported syndromes. It makes one wonder how any of us turn out normal, present company excluded.

Cardiology

Pediatric Cardiology for Practitioners by Parks et al. (4th edition) On Amazon.com, B. Kuhn calls this textbook: “easy to read and … supported by the style of the figures and schemes.” It provides knowledge about any congenital or acquired cardiac condition, with appropriate tables and cardiac values, along with the information needed to decide whether to refer to the cardiologist or not. This is a tremendous help for interpreting pediatric cardiac findings.

Breast-feeding

Breast-feeding: a Guide for the Medical Profession by Lawrence and Lawrence. (6th edition). This is the most thorough compendium of all things breast-and-feeding related. It includes a complete table on the drugs that pass through the breast milk, and their clinical implications, which cannot readily be found elsewhere. It details numerous pointers on managing breast-feeding, and warrants thorough reading by any physician who wants to provide the best advice to breast-feeding mothers. It is especially valuable for the male pediatrician.

Orthopedics

Two textbooks are the premier resources for evaluating an orthopedic problem.

The Injured Athlete by Perrin (3rd edition). This book provides excellent photographs and diagrams of joint and bone injuries along with a thorough guide on management and rehabilitation of injuries. Anyone performing a shred of sports medicine for their population would be well served by this tome, as it gives invaluable details never seen in pediatric training.

Practice of Pediatric Orthopedics by Staheli (2001 edition). I can truly declare: “Wow!” The exhaustive and extensive color photographs and diagrams include almost any possible orthopedic disease or injury one can ever witness. Make sure you get the color atlas version. The text is concise, and somewhat limited regarding management, but this is well worth the sacrifice to achieve this superlative level of pictorial quality.

The cost of these textbooks if purchased at one setting could be prohibitive. But one will be purchasing new editions at staggered intervals every four to five years for the textbooks. More than likely, one will spend about $200 to $250 annually.

Adolescent gynecology

Pediatric and Adolescent Gynecology by Emans et al (4th edition). I have been a devotee of this encyclopedic book on gynecologic problems for decades, and you should be also, no matter what age range of girls you care for. As Billings on Amazon.com proclaims: “It is a must for anyone seeing female patients in this age group.” The book is comprehensive and clearly organized, although subchapter headings and a few more summary tables would make it easier to cruise through. Still, if one needs to know the evaluation and management of polycystic ovary syndrome, dysfunctional uterine bleeding, amenorrhea, etc., no other resource is comparable.

Denouement

Oh by the way, I am currently still evaluating my adolescent female with the hot flashes whose carcinoid, ovarian failure, and neuroblastoma workup has been negative so far. When all else fails, consult with your very smart colleagues at the academic centers. My pediatric neurologist friend, Dr. Puri, has suggested that I treat her for vasomotor instability/orthostatic hypotension before I pursue any further workup.

On another note, I would like to recognize the incredible work and energy devoted to the world of pediatrics by Ralph Feigin, MD, a fact made all the more apparent when I saw his name twice as I wrote this column. I wanted to point out that not only is he the co-editor of the most comprehensive pediatric infectious disease textbook described above, but he is also a chief editor of the pediatric section of UpToDate.com and co-chief editor of the most widely-read and submitted-to pediatric journal, Pediatrics. This amazingly prolific physician deserves huge accolades.

About the author:

• Stan L. Block, MD, has a pediatric practice in Bardstown, Ky., and is a member of the Infectious Diseases in Children editorial board.