Emergency physicians often have a knack for making rapid diagnoses and initiating needed treatments quickly. Developing one’s ability to blend visual, historical and physical clues is generally based upon a combination of understanding basic pathophysiological mechanisms, identifying important historical and physical findings known to be associated with these pathophysiological mechanisms, and re-experiencing imprinted visual cues from prior cases. This visual diagnosis book, written by Holstege, Baer, Pines and Brady, takes advantage of all these features in an effort to serve as a valuable teaching tool for the physician or medical student seeking to improve their ability to rapidly diagnose important clinical conditions that may present to virtually any emergency department. The cases are not arranged by body system or by pathophysiological mechanisms (e.g., trauma, infectious disease, etc). Rather, they are presented similar to cases appearing in the emergency department. Thus, they appear in no particular order or sequence. Children are interspersed with adults and injuries with medical conditions. Each case is presented as an unknown along with a graphic illustration, brief case presentation, and management decision. The photos and line drawings are crisp and generally well demonstrate the patient’s abnormality, although some presentations may be subtle to the uninitiated. The answers provided later in the book are much richer than would be anticipated for a case presentation text. The discussions and supplemental illustrations create the impression that you have a seasoned emergency physician in the room who is walking you through the basic pathophysiological mechanisms and then clarifying the visual clues and their clinical significance. This detail gives you the confidence that you can
recognize and respond appropriately were you to re-experience these case presentations in the future. As a seasoned clinician, I eagerly read the case presentations first to verify my own rapid diagnostic skills and secondarily to determine if the authors would approach the problem as I would or if they would make different interventional recommendations. Although I am pleased that my interpretations were highly correlated with those of the authors, I found the richness of their discussion valuable for refreshing my understanding of the mechanisms behind the illness associated with each image. I anticipate that learners (whether novices or seasoned continued learners like myself) will appreciate what this book has to offer. It is fun and easy to pick up and begin the learning. Unfortunately, it is sometimes hard to put down for these same reasons. I anticipate keeping this text handy to reinforce key teaching points with medical students and residents. Others may find the text extremely valuable for preparing for the visual image portion of the emergency medicine written board examination. Those of us who have been away from our residency for some time will enjoy the text as a stimulus leading us to re-experience visual clues on conditions we simply don’t want to miss as clinicians. I anticipate that this text will be popular and eventually lead to subsequent "Visual Diagnosis" volumes. Our students and practitioners will be pleased to see these as well.