will be an adjunctive text in a medical library, I am not convinced that the usefulness of this text outweighs its shortcomings. Tillman Farley, MD Fort Lupton, Colo Fundamentals of Clinical Practice: A Textbook on the Pa- tient, Doctor and Society. Edited by Mark B. Mengel and Warren L. Holleman. 515 pp. New York, Plenum Publishing, 1996. 159.95. ISBN 0-306-45348-7. This book would be an excellent addition to commu- nity and behavioral medicine curricula in both resi- dency and medical school settings. Several of the au- thors are well-known teachers and researchers in family medicine. The textbook addresses the patient- physician relationship from a variety of angles. The first section addresses the patient, with chapters on hu- man health and disease and individual and family de- velopment; the second section deals with becoming and being a physician in today's challenging health care environment; and the third section describes the nu- merous contexts of family, community, the workplace, environment, culture, and economics that have an im- pact on the physician-patient relationship. The re- mainder of the book is devoted to special issues of health policy and economics, medical ethics, and the current problems of tobacco, alcohol, and drug abuse; violence; mental illness; sexually transmitted diseases; vulnerable and indigent populations; and maternal and child health. Overall, I found the book to be fascinating and well researched. This book successfully keeps the focus on the pa- tient-physician relationship by inserting case presenta- tions at regular intervals. The chapters are designed with cases and questions for small-group discussion at the end of each chapter. "\\'hen I used several of the chapters this past year during our community medicine rotation, the answers to some of the questions accompanying the case pre- sentations did not appear to be straightforward. A fa- cilitator's guide to accompany the cases and questions might be helpful. Additionally, the residents found that discussing cases which might not be applicable to their practice community to be less meaningful. Neverthe- less, the cases raised lots of good issues for discussion. This attempt at covering a broad range of topics is both successful and comprehensive. The book begins by focusing on the physician-patient relationship, adding layer upon layer until we can see in its entirety how complex and diverse practicing medicine can be, particularly in the context of worrisome public health issues. Medical schools and residency programs will find this textbook on the relationship of the patient, physician, and society a welcome resource as they strive to impart the community and public health im- plications of the physician's role. Sara Cate, MD Central Washington Family Medicine Yakima 84 JABFP Jan_-Feb.1998 Vol. 11 No.1 Manual of Skin Surgery-A Practical Guide to Dermato- logic Procedures. By David] LefJell and Marc D. Brown. 250 pp., illustrated. New York, Wiley-Liss, 1997. $45. ISBN:0-471- 13411-2. This textbook of excisional cutaneous surgery is de- signed for medical students, residents, and practicing physicians. The text begins with a review of basic prin- ciples of anatomy and skin pathophysiology and then focuses on specific procedural skills training for office- based care and procedures. The book contains 13 chapters on diagnosis, practical anatomy, wound heal- ing, skin biopsy, local anesthesia, surgical instruments, wound closure materials, patient preparation, basic ex- cisional surgery, surgical complications, special topics in dermatologic surgery, and risk management. The chapter on special topics helps the practitioner modify general approaches for special circumstances. One ap- pendix includes action guides for skin biopsy, pig- mented lesions, basal cell cancer, squamous cell cancer, and complications. These action guides are suggested algorithms in the work-up and treatment strategies. Another appendix includes vendors for dermatologic surgery products. The book can be understood by learners at any level. The index is detailed and easy to follow. The text uses drawings and color pictures to focus the reader. The drawings are extremely helpful, particu- larly in the challenging area of the face, where special anatomic consideration is given to recommended planes for elliptical excision. The strategy of the au- thors, beginning with basic principles of defining the lesion, reviewing the anatomy, and describing normal wound healing, followed by procedural considerations of anesthesia and biopsy, is very effective. Although there is no formal bibliography, there are suggestions for further reading with descriptions of seven other texts. It is important to understand that this text does not relate to skin disease but rather surgical ap- proaches to lesions. I believe that this reference is useful for the family practice clinic, is an excellent learning guide for family medicine residents, and provides a strong foundation for medical students. Best of all, its relatively low cost should allow even those on a limited budget to include it in a personal library. . Scott A. Fields, MD Oregon Health Sciences University Portland A Measure of My Days: The Journal of a Country Doctor. By David Loxterkamp. 321 pp. Hanover, NH, University Press of New England, 1997. 124.95 (paper), ISBN 0-87451-799-0. This is an engaging and important book that should take its place next to the classic photo-essay by Berger and Mohr, A Fortunate Man, which describes the life of the English country doctor John Sassall (Berger J, Mohr J. A fortunate man. New York: Pantheon Books, 1967). Each provides an intimate look inside the prac- o n 5 A p ril 2 0 2 1 b y g u e st. P ro te cte d b y co p yrig h t. h ttp ://w w w .ja b fm .o rg / J A m B o a rd F a m P ra ct: first p u b lish e d a s 1 0 .3 1 2 2 /1 5 5 7 2 6 2 5 -1 1 -1 -8 4 c o n 1 Ja n u a ry 1 9 9 8 . D o w n lo a d e d fro m http://www.jabfm.org/ tice of medicine and the life of the practitioner in the community. David Loxterkamp is a family physician in a small coastal town in Maine. In his 10th year in practice he chose to record his life with regular journal entries, which he then worked into this book. In doing so, he pulls the reader into his life and provides a very enjoy- able reading experience. In the process of examination he seems to have developed a fuller sense of self, home, family, and community, and we are privileged to share that journey. There is a chapter for each month of the year and for each of the four seasons, but the book is much more than an accounting of those days. By moving from the events of the day back into memory of earlier years and by anticipating the future, the author weaves a captivating narrative. The title indicates that the pages will reveal the daily life of a country doctor, and the book delivers on that promise. It reveals with hon- esty and candor the highs and lows and the growth of its author as physician, husband, father, and person of faith. It is a book about community and a deepening commionent to one community as home. Dr. Loxterkamp's gift with words ensures that the reader will experience the events and emotions of the days recorded. During the several days I was reading the book, I found myself experiencing elation, depres- sion, anxiety, and contenonent. At first I thought these emotions reflected the undulating circumstances of my own days, but I later concluded that was not so. I be- lieve the writing evokes in the reader the emotions and feelings of the author as he reacts to the circumstances of his life. I suspect also that each reader will react dif- ferently to the events described through memory of personal experience. A physician with community practice background will find this journal stimulates recall of the early years of establishing practice, home, and family. Some who felt isolation and frustration in those years might find reassurance that their experiences were not unique. Anyone who seeks to understand the practice of medi- cine in community would benefit from reading this work, as would those considering such a career. This book should be read by persons responsible for plan- ning, shaping, financing, or regulating community health care systems and organizations, for in doing so, they would develop an intimate understanding of the workings of such systems and the very personal needs they try to meet. Such an understanding cannot be found in the collection of diagnostic classifications, lists of symptoms, reports of encounters and proce- dures, and similar tabulations used to describe or eval- uate a medical practice. Dr. Loxterkamp reveals his life to be one of inten- sity, commitment, and searching. He also shares his contenonents and satisfactions. One might wish him more sheer joy and happiness than what seems to come through in the narrative. But, he says of himself (page 136): "There is always a tension between enjoying life and examining it." Theodore J. Phillips, MD Lopez Island, Wash Patients Are a Virtue: Practicing Medicine in the Pennsyl- vania Amish Country. By Henry S. Wentz. 175 pp. Morgan/GUm, Pa, MasthofPress, 1997. 112.95. ISBN 1-883294-49-5. Have you wondered what it would be like to practice medicine from 1948 to 1988 among the Amish in Lan- caster County, Pennsylvania? This fascinating period in medicine spanned the early years of antibiotics, the scourges of polio and rheumatic fever, the shift from solo to group practice, and the changes in health care financing from the $2 fee-for-service office visit to medical insurance to managed care. Dr. Wentz chronicles these events, covering four decades, through 39 short vignettes. He writes in a matter-of-fact, straightforward, conversational style that is most likely consistent with the way in which he practiced and cared for his patients. As he relates the satisfactions and frustrations of his practice, he inter- sperses reflections on lessons he learned, such as the value of nurses, the power of suggestion, the courage of patients facing adversity, and the importance of a supportive family and community for both patient and physician. Perhaps his most interesting insights evolve from experiences with his Amish patients that illustrate how their beliefs sustained them as they dealt with the challenges of life and death. He also describes the diffi- culties of getting the Amish to accept such preventive measures as prenatal care, well-baby examinations, and immunizations. Throughout these episodes Dr. Wentz conveys ac- ceptance of his patients, himself, and his times without undue moral judgment or philosophical speculation. Nevertheless, the reader becomes aware of the unique problems associated with practicing alone out of an of- fice in one's home, the stresses on marriage and chil- dren, the interruptions of family gatherings by patients with emergencies, and the concerns of losing patients to a competing physician in the community. Most of these stories are not particularly dramatic. Their impact arises from the cumulative descriptions of a type of practice that will not be repeated. A physi- cian emerges who appeared to possess the qualities necessary to succeed during a unique time in medical history within a geographical location enriched by people with distinctive motivations and moral princi- ples. Thus, this book might be of interest to those physicians who would like to know more about this way of life, to people living in the vicinity of Lancaster County, and to lay persons who wonder about the daily activities of a busy general practitioner. Vincent R. Hunt, MD Brown University-Memorial Hospital of Rhode Island Pav.'tUcket Book Reviews 85 o n 5 A p ril 2 0 2 1 b y g u e st. P ro te cte d b y co p yrig h t. h ttp ://w w w .ja b fm .o rg / J A m B o a rd F a m P ra ct: first p u b lish e d a s 1 0 .3 1 2 2 /1 5 5 7 2 6 2 5 -1 1 -1 -8 4 c o n 1 Ja n u a ry 1 9 9 8 . D o w n lo a d e d fro m http://www.jabfm.org/