Frameworks for Internal Medicine

I'm a new graduate NP working as a PCP at an FHQC. I bought this book to help me puzzle through cases that are too difficult for me to solve on my own (and with my mentors). Let me tell you about a patient whose life was changed because I own this book: I had one patient who presented at first with some dizziness and hearing loss- history of heavy drinking and SCLCa (currently untreated- but being monitored), neuropathy as a result of previous chemotherapy, and COPD. Over the course of the last 7 months, he had been getting progressively worse. Dizziness, diplopia, nausea, hearing loss, B/L weakness, unsteady gait. At the first visit, I ordered an MRIs to r/o metastasis to the brain. When this was negative, went on for further w/u: referred to neurology who came up with a + paraneoplastic lab which no one had any interpretations for (they told him to follow up in oncology). Oncology told me that this lab was insignificant and that the provider who ordered it should follow it up. (I was seeing patient for f/u between specialists). Now having B/L parasthesia, worsening balance (now using walker), ataxic gait, strabismus.... 4 months later with these worsening symptoms I do another MRI... no changes. Neuro thinks it is from the drinking. Oncology says negative for Ca. I send to ENT for the hearing loss- they confirm severe hearing loss without other suggestions. They send him back to me. Somewhere along the line I do a rheumo w/u and he has a +ANA : I'm not sure what it means in the context of his current symptoms and send him to rheumo on a hunch that this could perhaps be autoimmune & affecting neuro system: they say his ANA is positive from the cancer and no other suggestions there... He comes to see me again in the last 2 weeks- now wheelchair bound and unable to walk, slurred speech (at this point he has been to ENT x2, Neuro X3, Oncology X2, and Rheumo X1 and to me at least 5-6x). The family is beyond frustrated. I have no other ideas- I've talked to everyone else at my office for advice and not getting anywhere. I work through this book: And do you know what diagnosis I land on in the first 15 minutes of reading? Lambert-Eaton syndrome. Plain as day. Mind you: I have NEVER EVEN HEARD OF THIS DIAGNOSIS. I have never learned about it. It has never been casually mentioned at any lectures. At any rate, I send him to the ED and give report/summary that I am wondering if this is the cause.... He ended up getting immunoglobulins & sent for transfusion. I feel partially like a rock star, but it is 100% to the credit of this book. And the only thing I regret is that I did not use it sooner when I was trying to figure out what was going on. It's amazing how user-friendly this book is: a new graduate NP can navigate a lot of information easily & figure out a diagnosis that many specialists with MUCH MORE experience have missed. The lay-out of the content works beautifully to be just the right amount of information for framing a problem without taking a ton of time in the minutia. I came to the diagnosis after looking at the book for <15 minutes (of course, I was not SURE it was right, but MAN: It really got me there). I use this as my "light weekend reading" to solve cases that I'm struggling with and so far it has been indispensable to my practice. Sometimes UpToDate has SO MUCH information that it's hard to navigate/get a grasp on understanding some of the big concepts. I LOVE how this book connects and delineates pathophysiology by system/symptom & does not take a large time investment to see returns. It's an amazing reference and has helped me (and my patients!) immensely and I think EVERY provider should have it. Not only because you will feel smarter & get respect for solving difficult cases- but because it makes a real difference in patient outcomes & really helps deepen your understanding. If only I had a photographic memory! I can not recommend this book enough!!

This long awaited book is the perfect companion to both medical students and medical educators alike.For students:Shine on your medicine rotations as you build a fundamental "framework" approach to the most common complaints you will encounter in medicine. This book presents an easy way to organize a differential surrounding common complaints and provides high yield key points in bullet and question format. I really wish I had this resource as a medical student to quickly find an organized approach to different chief complaints. Now, as someone who helps educate students on medicine wards, I would be incredibly impressed by a student who is able to think through a differential in this organized manner that promotes long term retention.For educators:This is an incredible resource to reference when creating "chalk talks" on the medicine wards. Students tend to find these brief, high-yield, learning sessions very enjoyable and helpful. Having these "frameworks" to draw out really make for organized and effective teaching sessions. As an added perk, the book comes with a code to be able to quickly reference the frameworks on a mobile app.Overall, this is a long overdue gift to the field of medicine and I foresee this book becoming a household name amongst medical trainees. It is much more user friendly than pocket medicine and really provides a solid organized knowledge base that is very applicable to the clinical setting while highlighting high yield points for exams. I reference this heavily when creating brief "chalk talks" for students on the wards and I cannot recommend this enough! Buy this book!Note: I have no financial disclosure and did not receive any incentive to write this review. I just really love this book and want to spread the word!

Update

An intuitive way of learning internal medicine in a framework that makes recall simple and systematic. Would recommend for undergrads and postgrads alike

Bra bok

The schemas in the book are extremely well put and insightful. Definitely a must buy for anyone who’s trying to sharpen their diagnostic skills.

Es un libro bien estructurado, con esquemas diagnósticos, casos clínicos y método de preguntas-respuestas. Muy útil para residentes, adjuntos jóvenes y los ya más mayores que queremos seguir actualizados. Además ante un caso concreto sus esquemas te ayudan de forma rápida a no olvidarte alguna cosa más inusual. Muy recomendable