An advanced surgical resident in a modern American hospital may order a battery of laboratory tests, roentgenograms, ultrasonographic examinations, computerized axial tomographic scans, and even Doppler studies when he first sees a patient with acute pain. After sorting out the results of these tests, he will then proceed toward diagnosis. If things remain unclear, more tests will be ordered. Only as a last resort will he occasionally return to the bedside to further question his patient or to seek additional physical signs. For the generalist, the clinical examination plays an increasingly less important role, and it is an art lost altogether to many subspecialists.
Dr Hobsley's new book, Pathways in Surgical Management, comes as a refreshing surprise, but not because it stresses new approaches. Rather, it effectively resurrects some old ones. Here is an experienced voice that stresses (almost to the exclusion of modern technology) the information that can be