Abstract
In the 21st century what is the point of textbooks? After all they are out of date by the time they are published; they are usually not evidence-based, reflecting the prejudices of their authors; and usually you can't easily carry them around with you. Compare this with publications such as Clinical Evidence which is available in a computerized ‘handheld’ version, the contents systematically written and updated at least annually. The argument often put forward for continuing to have textbooks is that they are easier to read, they are aesthetically pleasing and they can still be important for explaining fundamental principles.
So how does the Massachusetts General Hospital Handbook of General Hospital Psychiatry stack up? Firstly a handbook it is not, it comes in at just over 800 pages and 1.5 kg. The book consists of 46 chapters written by 80 different authors most with some affiliation to Massachusetts General Hospital. Since the last edition over 20 new chapters have been added which vary in style and emphasis. Some have a practical emphasis such as Difficult Patients by James Groves, which I would recommend any registrar in consultation-liaison psychiatry read.
Like most North American textbooks it barely recognizes a world outside the USA which the references and examples reflect. So in the chapter on Diagnostic Rating Scales and Laboratory tests, the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders (SCID) is said to be the most commonly used diagnostic instrument in psychiatry (sic) whilst the World Health Organization's Schedule for Clinical Assessment in Neuropsychiatry (SCAN) is not even mentioned. One of the chapters is entirely devoted to billing documentation and cost effectiveness of consultation. Also there is an emphasis on biological treatments – with only 10 references to cognitive behavioural therapy in the book compared to say 17 for clozapine.
A major problem with this book is that although it is now in it's 5th edition and was published this year it is simply out of date (some chapters seem to have been barely altered from previous editions), and parochial. For example the chapter on somatization contains 107 references but only 6 are from the past five years and the majority are from the 1980s and early 1990s. There is also the occasional idiosyncratic throw away comment such as in the somatization chapter where the authors recommend using the MMPI and projective tests, such as Rorschach ink blots, in the assessment of somatizing patients (sic) – no references are provided. Curiously the chapter on suicide makes no mention of deliberate self-harm, attempted suicide or how to address the problem of providing services to this group of people. Again here the references are dated with an emphasis on North American studies – of the 101 references only 10 are more recent than 1995 (!).
What is good about this book is that there is a lot of information in one place which makes it a convenient starting place for seeking out further information. The case examples also make it easier to read and illustrate in a useful way the points the authors are trying to make.
So is this book a good example of a textbook at the start of the 21st century? Unfortunately not as it provides an example of everything that the critics of textbooks make – it is not systematic, it is out of date and it is not evidence based. The definitive text book on consultationliaison psychiatry remains to be written. In the future this may take the form of a core text, a CD with videoed case examples and a dedicated web site which regularly updates the text. Until then doctors who wish to inform themselves about general hospital psychiatry would probably be better off developing a powerful reading habit and buying a subscription to one of the consultation liaison psychiatry journals than spending US$58 on this book.