Bates’ Guide To Physical Examination and History Taking 13th Edition

Book Preface

For more than 40 years, Bates’ Guide to Physical Examination and History Taking has been the singular authoritative source for students of medicine, nursing, and rehabilitation and others who are learning the skills of an effective, safe, and efficient patient clinical encounter. It also has been the preferred textbook of clinical skills program directors and educators in the United States.1 Since its inception by Drs. Barbara Bates and Robert Hoekelman in 1974, topics relating to the physical examination and the clinical interview have served as the core content of the textbook for teaching and learning clinical skills. The thirteenth edition marks a significant expansion of the scope of the textbook to include the remaining critical components and features of the clinical encounter and now comprises 27 chapters. As authors, we remain committed to providing you with the critical concepts and frameworks you will need to understand and retain material as you encounter abundant new evidence supporting the techniques of examination, interviewing, health promotion, and disease prevention.

New Content and Features

The thirteenth edition has new and expanded content as well as unique features to facilitate student learning and clinical skills education.

Six new chapters expand the scope of the textbook to better delineate all aspects of clinical skills training and education.

The opening chapter now focuses on the patient encounter, including critical elements such as the use of preferred names, gender pronouns, the approach to special populations including persons who are differently abled, and discussions of LGBTQ health medical ethics and racism in health care.
Frameworks of advance communication and interpersonal skills are expanded, including communicating difficult news using SPIKES and Ask-Tell-Ask methods; motivational interviewing and teach-back methods in patient communication; and the SBAR method for interprofessional communication.

A stepwise approach to the process of clinical reasoning includes an emphasis on the use of illness scripts and semantic qualifiers and the development of summary statements with illustrative examples.

A key regional chapter, Head and Neck, is subdivided into smaller chapters for a more focused understanding of its component organ systems and their pathophysiologic interconnectedness.
General health maintenance screening and counseling topics are organized into a single chapter for easy access that includes informative tables of updated recommendations.
All regional chapters follow a uniform template that facilitates locating critical information.

Key terms commonly discussed in clinical rounds and rotations are highlighted in bold text throughout the textbook, and their “must-know” definitions are located in a glossary available in the eBook.
Summary checklists of key physical examination steps are included in the regional examination chapters for review purposes.

Many of the figures are new or provided with more descriptive captions.
For the first time, all textboxes are numbered to make them easier to locate and reference in both the print and electronic editions.

Organization

The book comprises three units: Foundations of Health Assessment, Regional Examinations, and Special Populations.

Unit 1, Foundations of Health Assessment, consists of chapters that follow a logical sequence beginning with an overview of the components of the patient encounter, followed by important concepts in assessment of clinical evidence and clinical decision making.

Chapter 1, Approach to the Clinical Encounter, features the sequence of the key elements of the clinical encounter using the Enhanced Calgary-Cambridge Guides as a framework. This chapter also includes general approaches to establish rapport with different age groups and persons with varying physical and sensory abilities. It also includes foundational concepts on social determinants of health, medical ethics, and bias in health care.

Chapter 2, Interviewing, Communication, and
Interpersonal Skills, presents the techniques of skilled and advanced interviewing. Expanded topics include informed consent, working with medical interpreters, discussing advance directives, and disclosing serious news. This chapter also provides approaches to challenging patient behavior and situations.

Chapter 3, Health History, describes the components of the health history and effective interviewing techniques for eliciting the patient’s history. Differences between comprehensive and focused health history taking are also discussed. Techniques for transforming information gathered in the interview into the structured format of the written health history are also described. There are expanded discussions of the sexual health history and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) model for behavioral modification as well as general approaches to tailoring the health history for specific patient situations. Chapter 3 also presents guidelines for creating a clear, succinct, and well-organized patient record including helpful templates for constructing the History of Present Illness.

Chapter 4, Physical Examination, provides a model for sequencing the art and science of the physical examination that optimizes patient comfort. This new chapter includes a section of required equipment and their descriptions as well as guidance for modifying the examination for various care sites and situations.

Chapter 5, Clinical Reasoning, Assessment, and Plan, was expanded and rewritten for the thirteenth edition by Drs. Rainier Soriano and Joseph Truglio. It provides a discussion of the basic steps of the clinical reasoning process highlighted by key concepts of the use of illness scripts, semantic qualifiers, and the construction of summary statements (problem identification). Helpful memory aids and illustrative examples are also provided to help students master this complex skill of synthesizing information gathered from the clinical interview and physical examination to develop an assessment and plan. The chapter also provides guidance on giving oral presentations of your patient and their clinical findings.

Chapter 6, Health Maintenance and Screening, is one of the new chapters written for the thirteenth edition by Drs. Richard Hoffman and Rainier Soriano and organizes the various general health recommendations for screening and counseling from the U.S. Preventive Services Task Force (USPSTF) into a single chapter.

Chapter 7, Evaluating Clinical Evidence, was streamlined for this edition by Dr. Richard Hoffman and clarifies key concepts to ensure student understanding of the use of history and physical examination as diagnostic tests; tools for evaluating diagnostic tests such as sensitivity, specificity, positive and negative predictive values, and likelihood ratios; types of studies that inform recommendations for health promotion; and an approach to critical appraisal of clinical literature and types of bias.