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Piccini & Nilsson: The Osler Medical Handbook, 2nd ed.

About This Book

"Basically, a medical text is deemed worthy of widespread use when it is able to convey cutting-edge data in a clear and

cogent manner. And that's just what the authors and editors of Osler's have done with this manual." -- The Electric

Review

Written by experts at the Johns Hopkins Hospital, this brand-new 2nd Edition covers all of

the essential topics encountered in daily practice. It concisely discusses all diseases and

disorders in an easy-to-follow, standardized outline format. Each chapter includes sections

on pearls and pitfalls, differential diagnoses, algorithms, and reviews of the most current

literature. And, comparative pharmacology tables provide instant access to essential

information.

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Piccini & Nilsson: The Osler Medical Handbook, 2nd ed.

The Osler Medical Handbook

Second Edition

The Osler Medical Service:

The Johns Hopkins Hospital:

Kent R. Nilsson Jr., MD, MA Jonathan P. Piccini, MD

Dedication

To my beloved wife, Heidi, for her love and devotion, and to my daughters, Annika and Ingrid, who daily remind me of

the joys of life. Finally, to my parents, Kent and Marjorie, for their unfailing support.

KRN

To my wife, Megan, for her patience, love, and the joy she brings into my life each and every day, and to my parents,

Paul and Joanne, for their encouragement, guidance, and endless generosity.

JPP

SAUNDERS ELSEVIER

1600 John F. Kennedy Boulevard

Suite 1800

Philadelphia, Pennsylvania 19103-2899

THE OSLER MEDICAL HANDBOOK

Second Edition

ISBN-13: 978-0-323-03748-8

ISBN-10: 0-323-03748-8

electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without

permission in writing from the publisher. Permissions may be sought directly from Elsevier's Health Sciences Rights

Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail:

healthpermissions@elsevier.com

. You may also complete your request on-line via the Elsevier homepage

(http://www.elsevier.com

), by selecting “Customer Support” and then “Obtaining Permissions.”

NOTICE

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our

knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are

advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of

each product to be administered to verify the recommended dose or formula, the method and duration of

administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience

and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual

patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the

Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use

of the material contained in this book.

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Library of Congress Cataloging-in-Publication Data

The Osler medical handbook/Osler Medical Service, Johns Hopkins Hospital.—2nd ed./

editors, Kent R. Nilsson, Jr., Jonathan Piccini.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-323-03748-8

1. Clinical medicine—Handbooks, manuals, etc. 2. Primary care (Medicine)—Handbooks, manuals, etc. 3.

Medicine—Handbooks, manuals, etc. I. Nilsson, Kent R. II. Piccini, Jonathan. III. Johns Hopkins Hospital. Osler

Medical Service.

[DNLM: 1. Clinical Medicine—Handbooks. WB 39 O825 2006]

RC55.O87 2006

616—dc22

2005057670

Publisher's Team

Acquisitions Editor: Joanne Husovski

Developmental Editor: Patrick M. N. Stone

Senior Project Manager: Cecelia Bayruns

Design Direction: Karen O'Keefe Owens

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

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Piccini & Nilsson: The Osler Medical Handbook, 2nd ed.

Sir William Osler

Sir William Osler (1849–1919)

Nearly a century after his death, Sir William Osler is still probably the most famous and oft-quoted physician in North

America and in Europe. Over the course of his professional life at McGill University, the University of Pennsylvania,

Johns Hopkins University, and Oxford University, he placed an indelible stamp on medical practice and teaching that

persists to this day.

William Osler came to Johns Hopkins in 1889 as the first chief physician of the new Hospital and School of Medicine.

He wanted to create a hospital and school that would be “a place of refuge for the sick and poor of the city—a place

where the best that is known is taught to a group of the best students—a place where new thought is materialized in

research—a school where men are encouraged to base the art upon the science of medicine—a fountain to which

teachers in every subject would come for inspiration—a place with a hearty welcome to every practitioner who seeks

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help—a consulting center for the whole country in cases of obscurity.” The spirit of dedication to patient care,

teaching, and research that was instilled by Osler and his colleagues remains the mission of the Johns Hopkins

Hospital and the School of Medicine.

It was during Osler's time at Johns Hopkins (1889–1905) that he wrote Principles and Practice of Medicine . Osler was

a renowned author even before he took on the task of singlehandedly writing a state-of-the-art, comprehensive

textbook of medicine. His book was “designed for the use of practitioners and students of medicine” and was the first

modern textbook that took a scientific approach to the diagnosis and practice of medicine. Principles and Practice of

Medicine , first published in 1892, was a worldwide success and greatly enhanced the professional stature of

physicians because it rooted medicine in science and in rigorous observation. The explosion of medical publishing

over the past 100 years can be traced to the publication of this remarkable book.

Another of Osler's legacies is the Osler Medical Housestaff and the Osler Medical Service at the Johns Hopkins

Hospital. Although in Osler's day medical training commonly included a period of residency, he was among the first to

appoint residents to his own service based on their intellectual prowess as well as their personal characteristics. He

valued collegial interactions and believed strongly that because the attending physician and resident would have

frequent intense contact, they should have similar values and goals for improving health, understanding medicine, and

communicating with patients. He led and taught by example, advising his students to “care more particularly for the

individual patient, than for the special features of the disease” and frequently reminding them that “medicine is learned

by the bedside and not in the classroom.” These principles remain the foundation on which clinical education and

housestaff training are based at Johns Hopkins. Osler did not minimize the value of scholarship and reading. His

scholastic expectations for physicians and trainees were extremely high. He expected doctors to read about their

cases and to have a current understanding of pathophysiology: “It is astonishing with how little reading a doctor can

practice medicine, but it is not astonishing how badly he may do it.”

It is the spirit of professionalism, scholarship, and collegiality that led to the creation of The Osler Medical Handbook .

In 2002–2003, the year the first edition of this book was published, it was apparent that then-interns Kent Nilsson and

Jon Piccini had all of the intellectual and personal characteristics to steward the second edition of our book. In addition

to the monumental task of organizing a large group of housestaff and faculty colleagues, they identified and

implemented a number of improvements to make the second edition of The Osler Medical Handbook even more

usable for house officers and inpatient physicians. These improvements include a more usable and structured chapter

design, a thinner book despite the inclusion of many new chapters and topics, and a continued dedication to providing

evidence-based practical clinical recommendations. On behalf of the past, present, and future Osler Medical

Housestaff, we offer this book to our colleagues in the spirit of a passion for patient care, scholarship, and education.

As the current Program Director of the Osler Medical Housestaff, I have immeasurable pride in our housestaff, who

daily perpetuate the values that William Osler lived and taught at Johns Hopkins. We hope that this book, which is

also “designed for the use of practitioners and students of medicine,” is as useful and as successful as was his.

Charles M. Wiener, MD

Vice Chairman, Department of Medicine

Director, Osler Medical Training Program, Johns Hopkins School of Medicine

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