Vital questions to ask in the ER

James Maskalyk

Theresa Spruill and Michael S. Lippe

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Malden (MA): Blackwell; 2002. 126 pp. US$19.95(paper) ISBN 0-632-04668-6

Rating: *

Audience: Medical students

Content: This short book is intended to guide medical students successfully through patient interviews in the emergency department. Each of the 39 chapters is devoted to a common presenting problem ranging from abdominal pain to motor vehicle accidents to vaginal itching. Ten to 40 questions are offered, along with a short explanation of why each is important. In the margins, and at the end of each chapter, are highlighted reminders of crucial points.

Strengths: The complaint list is fairly comprehensive and represents most encounters in the emergency department. The lists of questions, although poorly structured, address the most serious pathology.

Limitations: This is intended as a “pocketbook” to accompany “the busy medical student in the emergency room.” Unfortunately, little attention is paid to developing a structured approach, and the “list” method does not provide a foundation on which to build medical knowledge. A better approach might have been to provide an ideal interview format, regardless of complaint, and then apply this structure to particular pathologies. As it stands, the questions have little logical flow, and unless the student is conducting the interview with the book in hand, a comprehensive list of questions would need to be memorized. Omitting one (which is likely) might delay diagnosis. No mention is made of the unique environment of the emergency room, or of how an interview must be concise but thorough. For instance, in the section on back pain, a recommended question asking for a history of fibroids precedes characterization of the pain with movement. Such ordering is inefficient, and in the absence of a proper context, not useful. The highlighted text is distracting and unhelpful. An example, in the section on abdominal pain, is “With the advent of the World Wrestling Federation there will be more abdominal trauma, especially in childdren [sic] and teens.” It is disappointing that this book does not live up to its promise, for such a supplement to an emergency rotation would be welcome, particularly given the expectations made of students asked to see patients on their own. A wise student would save her money, read her notes on how to conduct an interview, and ask her seniors to help refine her technique.

James Maskalyk

Editorial Fellow, CMAJ

PGY-4, Emergency Medicine

This book is available through your local book retailer, or through the publisher at www.blackwellpublishing.com/book.asp?ref=0632046686