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                         MARCH 2019 V42, NO.3
                                                               BOOK REVIEW
                                                    BOOK REVIEW:  
                 FRAMEWORKS FOR INTERNAL MEDICINE
                                                       Avital Y. O’Glasser, MD, FACP, FHM
                                Dr. O’Glasser (oglassea@ohsu.edu; Twitter, @aoglasser) is a hospitalist at OHSU and an  
                                       assistant program director for the Internal Medicine Residency Program.
               t gives me great excitement to                                                      The book is incredibly com-
               introduce and review the new                                                   prehensive, spanning fifty chapters 
            Iinternal medicine textbook                                                       covering the most common internal 
            Frameworks for Internal Medicine                                                  medicine pathology—structured by 
            by Dr. André Mansoor for the SGIM                                                 symptoms (e.g., dyspnea or chest 
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            Forum audience.  This incredible new                                              pain), physical exam findings and 
            book has been published by Wolters                                                vital sign abnormalities (e.g., edema 
            Kluwer and is available directly from                                             or tachycardia), laboratory abnormal-
            the publisher as well as other sellers,                                           ities (e.g., hypo/hyperkalemia), and 
            including Amazon.                                                                 diagnoses/syndromes (e.g., endocar-
                In the day and age of a plethora                                              ditis or cholestatic liver injury). Each 
            of online-based resources and chang-                                              chapter utilizes flow diagrams to 
            es to traditional medical school book-                                            build schemas based on an introduc-
            store structures, why am I recom-                                                 tory case example, followed by ques-
            mending a new textbook for you? At                                                tion-answer pairs. As each chapter 
            this time when digital-based mediums                                              progresses through its schema, layers 
            are becoming more prolific, including streaming medical       of additional complexity and nuance build on the early 
            school classes, this book will ground you back to the         framework. If you have any question about depth and 
            bedside.                                                      breadth of the book, let me inform you that the index 
                Frameworks for Internal Medicine is a book that           alone is 21 pages long.
            is centered around and simultaneously heralding the                In the foreword, Dr. Lynn Loriaux, former chair of 
            importance of diagnostic frameworks. In the preface, Dr.      the Department of Medicine at OHSU, writes, “This 
            Mansoor reflects on learning from building differentials      book preserves the art of Socratic teaching…not only 
            as a medical student, usually waiting for someone to be       does the process reveal what is known but, even more 
            “right” though hitting moments of impasse when the            clearly, it reveals what is not known” (p. vi). With this 
            differential could not be expanded upon. Fondly remem-        emphasis on question-answer formatting, the book will 
            bering a Chief Resident’s use of diagnostic frameworks,       likely conjure memories of Dr. Salvatore Mangione’s 
            he highlights their value: “with this framework for           great Physical Diagnosis Secrets.2 In the true spirit of ed-
            approaching weakness, we had achieved what seemed             ucation, the book also includes an Educator’s Appendix 
            impossible moments before” (p. vii)—permitting us to si-      reviewing the value of “chalk talks” and how to apply 
            multaneously develop broad differentials, hone diagnos-       the frameworks system to such.
            tic plans based on a schema, and narrow that differential          Now that I am well into this book review, I con-
            based on pre-test probability. During his own time as a       fess that I must admit my own bias in this piece. I have 
            chief resident, he “discovered that the guidance from the     known André for just over 11 years exactly, when he 
            framework alone was enough to result in a meaningful          was that very MS3 on his internal medicine clerkship 
            teaching session” (p. viii)—and now, six years later, this    (as he writes about in the preface) and I was an intern—
            book is the culmination and assemblage of his desire to       we worked and learned together on the same general 
            teach via frameworks.                                                                                continued on page 2
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            SGIM FORUM MARCH 2019 V42, NO.3    SHARE
            BOOK REVIEW (continued from page 1)
            medicine team at the Portland VA.          dive and were often peppered with              People may talk about how this 
            His zeal for internal medicine was         literature citations, rather than being   book reflects his blood, sweat, and 
            infectious then, and to this day, we       signed quickly in a “get by” fashion.     tears over the last six years since 
            reminisce about memories from                  André is still the attending who      he was a chief resident—and I can 
            that stretch. I have had the utmost        takes full advantage of the white         confirm that he has poured himself 
            pleasure and privilege of watching         boards scattered around the med-          into this book. I cannot think of any 
            his career trajectory take off since       icine units at OHSU, and it is not        better way for a tangible object to 
            then, and I feel the two of us have        unusual to come around a corner to        reflect who a clinician is at their very 
            spanned the arc of medical training        see him standing at one delivering        core. His love of learning and medi-
            experiences together—he was my in-         an impromptu teaching session. His        cine, as well as teaching, is palpable 
            tern when I was an R3 on wards, my         style answering pages from nurs-          throughout this book. I hope you 
            R3 when I was a still relatively new       es and ancillary staff is similarly       will find it educational and conta-
            attending on wards, and we remain          educational (and as Dr. Loriaux           gious—and help you drive forward 
            colleagues in the same division.           also points out in the foreword,          both medical education as well as 
            When our residency program still           when Socratic Method is used in           clinical care. 
            had every fifth overnight admitting        the clinical setting, “Everybody               I am sure that it will deservedly 
            shifts on medicine wards, we would         learns. Students, teachers, and           become a time-honored masterpiece, 
            stay awake writing notes, sharing in       nurses learn…patients learn” [p.          and it is beyond deserving of a place 
            the excitement of patient care and         vi]). His track record of publishing      on your bookshelf.
            learning, listening to his favorite        clinical images (often accompanied 
            Michael Jackson radio station. He          by sound/video clips on the online        References
            was also the intern, both during           version) of physical exam findings        1.  Mansoor AM. Frameworks for 
            daylight hours and on overnight            is proof of his ability to observe             Internal Medicine. Philadelphia: 
            admitting shifts, who would pop up         and analyze in the moment. You                 Wolters Kluwer, 2019.
            to the white board at the slightest        may also find him on Twitter as           2.  Mangione S. Physical Diagnosis 
            question from a student and deliver        @AndreMansoor, where he has                    Secrets, 2nd ed. Philadelphia: 
            an on-the-fly chalk talk in the team       launched an image-based question of            Elsevier, 2007.
            room. Admission notes had a deep           the week series.                                                              SGIM
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