A. Moulds

JOHN JOHN FRY FRY All All examinations examinations create create problems problems and and stresses stresses in in examinees. examinees. The The examination examination for for the the Membership Membership of of the the Royal Royal College College of of General General Practitioners Practitioners is is no no exception. exception. Although Although the the examiners examiners state state that that their their objectives objectives are are to to pass pass candidates candidates wherever wherever and and whenever whenever possible, possible, nevertheless nevertheless the the failure failure rate rate remains remains con­ sistently sistently at at 30% 30% plus plus of of those those taking taking the the examination. examination. The The reasons reasons for for failure failure fall fall into into a a number number of of groups. groups. The The candidate candidate may, may, through through over-confidence, over-confidence, not not have have prepared prepared for for the the examination. examination. He He may may have have assumed assumed that that it it is is not not necessary necessary to to read, read, learn learn and and digest digest data, data, facts facts and and experience experience on on general general practice. practice. How How wrong wrong that that is, is, he he will will discover discover when when he he sits sits the the exam. exam.

This book has been written to provide general practitioners with an easy to read, easy to consult guide, to aid in the management of the large majority of practice emer­ gencies. Each presenting problem is approached logically with telephone assessment and advice followed by the assessment and management necessary when the patient is seen. The emphasis is on practical primary care with discussion of differential diagnosis only taken as far as is needed for deciding the best immediate course of action. Words are kept to a minimum though tables are liberally used to summarise useful information. For each situation the final management advice is highlighted by being presented within a heavily lined box. Our guiding principles for emergency care, which this book naturally reflects, are: (1) Visit first - argue or educate later. (2) If in doubt - see the patient. To use this book for ready reference by the telephone, in the car, or at the bedside: (i) If the patient is a child, look at the contents list at the beginning of chapter 4 and then turn to the relevant pages. (ii) If the patient is an adult, first decide the system involved then look at the contents list at the beginning of the appropriate chapter before turning to the relevant pages.

Although we have no good definition of 'health', all people have their own ideas of whether they are healthy or not. Based on personal experience and knowledge each person comes to accept that within themselves there is a normal range of feelings and performance, departure from which could be considered abnormal or unhealthy. Despite the many amazing technological advances made over recent decades it cannot be said that access to advanced medical care is the main determining factor in the healthiness or otherwise of a society. Even in these modern times most diseases and health problems are non-curable in the strict sense, and the scope for effective prevention of disease is more limited than some enthusiasts suggest. Individuals must appreciate the limitations of modern medical care and, while seeking to use the care available to best possible effect, accept that the responsibility for trying to prevent major disease rests in their own hands. In this book we have tried to present a balanced and realistic picture of the many factors that must be taken into account if optimum disease prevention and health maintenance are to be achieved. The health of your family is your responsibility. An understanding of what can go wrong, how it can be prevented or how it can best be coped with can only be helpful to you.