Book Review:
Concise story of patients' clinical problems
Clinical Surgery
Made Easy
Author: Professor Mohan de Silva, MS, FRCS,
tim Publishing Limited,
Shrewsbury, UK.
First edition 2008.
242 pages.
Fashions in allopathic medical practice seem to change almost as
often as fashions in women's designer clothes. And trends in the
relatively young specialty called 'medical education' must perforce
strive to keep pace to justify its raisons d'etrč.
Hence we have in the past three decades or so witnessed a
proliferation of fashionable technical jargon such as patient management
plans, best evidence-based practice, and clinical guidelines in the
domain of medical and surgical practice, and learner-centred teaching,
problem-based learning, laterally and vertically integrated
teaching/learning, and learning objectives (recently metamorphosed into
'outcomes') in the field of medical education.
The temptation to follow fashion is strong, and its allure frequently
irresistible. To be perceived as being out of step with fashion is to
court derision from colleagues and rejection by internet-educated
patients. In medical practice as well as in medical education, fashions
may come and fashions may go, but some things must be everlasting. In
clinical practice they include competence, compassion, and respect for
human life and patient autonomy. In medical education I choose two
definitions above all else: that of 'learner' (an individual who wants
to learn) and 'teacher' (someone who loves to teach, and does so with
flair).
An outstanding academic clinician
Professor Mohan de Silva belongs in that special galaxy of
outstanding products of the Colombo Medical School who embody all the
defining characteristics demanded of an academic clinician: humane
compassionate doctor, dedicated teacher both in precept and practice,
accomplished researcher, and of course, brilliant surgeon. And now he
has further extended his repertoire of talents to writing a book on
clinical surgery, principally for medical students and young doctors.
The book comprises 28 chapters: the first and second are devoted
respectively to the rational approach towards clinical surgical problems
and the general principles involved in solving them. The other chapters
are a series of step by step analytical discussions, each one dealing
with a common surgical problem e.g. breast lump, dyspepsia, altered
bowel habits, head injury, acute abdomen, thyroid mass, scrotal
swelling, bladder outflow obstruction etc. The other special features of
the chapters are a problem-solving approach, and a distinctive clinical
management focus based on fairly straightforward clinical skills and
current best evidence.
Each chapter begins with a clear statement of learning objectives and
a concise story of a patient's clinical problem, followed by a resume of
the findings on clinical examination and initial investigations, a
tentative management plan and timely reminders of the patient's
progress. As in real life clinical situations, the rest of the story
unfolds steadily but unhurriedly, often with several intriguing twists
and turns such as an unexpected laboratory test result, an MRI scan
finding or a biopsy report. Management plans may then need some
modification or even radical revision. These could predicate a profound
change in the prognosis of the disease which can challenge the
communication skills of the most experienced clinician.
Probing questions for readers
At strategic points in the narrative the author introduces questions
that probe the learners' core knowledge in anatomy, patho-physiology,
biochemistry and clinical surgery. Is CEA useful in the diagnosis of
colorectal cancer? Could this patient be having a perforated peptic
ulcer? What is prostate specific antigen? He provides succinct answers
to these question so that the narrative does not lose either its
momentum or mesmerising quality. The narrative is punctuated also by
particularly valuable "clinical points" in prominent boxes. Here is a
small selection: puckering of the skin strongly indicates that there is
an underlying malignant lesion (of the breast); jaundice, pale stools
and pruritus (itching) are the classical clinical features of
extrahepatic biliary obstruction; anal fissure is the commonest cause of
anal pain; CEA is not recommended for colon cancer screening. The
importance of multi-displinary team meetings and recourse to
internationally accepted guidelines in clinical decision making are
regularly emphasised.
The other attractive attributes of Professor Mohan de Silva's book
include appropriate and illustrative photographs - most of them in
colour - and clear line diagrams, and at the end of each chapter, four
or five objective self-assessment questions that tend to stimulate
reflection and reinforce learning.
In my view, the key messages underpinning the book's thematic
chapters are: have a strong and comprehensive core knowledge foundation
of the basic sciences relevant to medical practice, hone your clinical
skills, be a reflective, rational and analytical clinician.
Senior medical students and young doctors finding their feet in what
is surely the most demanding field of human endeavour and most
emotionally rewarding profession will find this book a very helpful
guide whatever specialty they intend to pursue. Clinical teachers of all
specialties would do well to emulate its systematic approach. Medical
libraries should stock it in their book-shelves. And Professor Mohan de
Silva deserves to be congratulated for having produced it.
- Vidya Jyothi Professor Colvin Goonaratna,
FRCP, PhD
Email: [email protected]
Sri Lanka's first International film festival coming soon
Ruwini JAYAWARDANA
Today marks yet another milestone in Sinhala cinema's 61 year history
when plans for the first ever 'Galle Film Festival' (GFF) will be
announced amidst some of the most renowned figures of the industry from
around the world.
The event follows in the footsteps of the 'Galle Literary Festival'
which had been successfully held for two consecutive years. Hosted for
the first time in the picturesque locations of the Southern fringe of
Galle, the event is dubbed as the largest annual international cultural
event in the island as well as in the South Asian Region.
Three fund raising evenings will be held on October 25 and 26 and
November 1 and 2 to announce this gala event and to explain its
objectives. The Festival will be held in 2009 where 40 Sri Lankan films
together with a number of South Asian and International films will be
screened. A line-up of workshops, lectures, panel discussions and
question-answer sessions will also be a part of the festival. The
festival is set to cover a number of genres including Sri Lankan movies,
award winning feature films, documentaries and creations from upcoming
filmmakers. Channa Deshapriya, Sam de Silva, Elissa Down, Erik Thomson,
Lester James Peries, Sumitra Peries, Ravindra Randeniya and others will
patron the event.
Today's event will open with the South Asian premier of two renowned
films, Paul Schrader's 'Adam Resurrected' and Ketan Mehta's Rang
Rasiya(Colours of Passion). A colourful premier parties will follow the
films. Schrader and Shekhar Kapoor, the Indian born filmmaker of 'Bandit
Queen' and 'Elizabeth' will attend and speak at the event organised by
renowned film producer, Damita Nikapota, Founder of Galle Literary
Festival, Geoffery Dobbs and talented filmmaker, Boodee Keerthisena, who
is the festival director, together with the National Film Corporation. |
