Health assessment textbooks: a brief review

Health assessment is the process by which health care professionals (HCPs) perform a physical exam, take a health history, and determine whether and in what way a patient is in ill health. Most people think of this simply as the physical exam. As a patient, undressing and getting poked and prodded by a doctor or nurse is the most distinctive part of a doctor's appointment or trip to the hospital. For a good HCP, the whole procedure is much more involved than poking and prodding. In order for the physical exam to be meaningful, it has to be joined by an adequate knowledge of the patient's background, lifestyle, and complaints. Thus, a textbook for teaching health assessment has to cover physical exam techniques for all the bodies' organs and physiological systems as well as common pathology (what does a cancerous mole look like compared to a non-cancerous one?) and advice on interviewing and interacting with the patient.

In school I was disappointed in my health assessment class, and although I thought our textbook was adequate, I was interested to know how else the course might have been taught and what other decisions might have been made about the content. So after school I ordered some alternate health assessment textbooks to compare with the one we had been assigned, Jarvis' Physical Examination and Health Assessment. I found Bates' Guide to Physical Examination and History Taking and Mosby's Guide to Physical Examination. Was Jarvis the best our program could have done, and did I learn anything abstractly about health assessment from comparing these books?

As a matter of fact, I think Jarvis' book was the best our program could have done. The three books--which I'll call Jarvis, Bates, and Mosby--from editions published in 2003-04--all essentially purport to serve the same purpose. The introductions say they are for beginning or first-year health students. I'm not sure who else bothers with physical examination than nurses and doctors/PAs. And I'm not really sure that medical education is framed with a single "health assessment" academic course the way a nursing program might be, although it seems to be implied by the introductions of these books. My guess is that medical schools vary in the way teaching of physical examination techniques are integrated into the curriculum. Since each of these books contains an overview of relevant anatomy for each system (cardiovascular, skin, etc), I find it hard to believe that a medical school would bother assigning any of these books after a gross anatomy course, but perhaps.

Moving on: the books are organized essentially the same way (an introduction to taking a health history with interpersonal and cultural considerations, etc, followed by sections devoted to the physical assessment of individual bodily systems), but with some characteristics that mark them distinctively. First is authorship. Bates is authored by medical doctors, while Jarvis is authored by a nurse practitioner, and Mosby authored by a mix of health professionals including doctors and nurses. The fact that Jarvis does not have a medical doctor as author clues us that its intended audience is nursing students, while the opposite is true of Bates. And these clues are supported by the second distinctive characteristics, which are the supporting or "extra" material. I refer here to the fact that Jarvis makes a point of including sections on NANDA-approved nursing diagnoses, while Bates includes information specifically related to the construction of a History & Physical document. Mosby, again, is sitting on the fence, but its inclusion of appendices giving definitions of abbreviations and word parts suggests that the intended audience has less education than a typical medical student.

One of the things I was interested in was the content of the books, and besides browsing the books, I took a closer look at the sections on cardiac and skin assessments. In general, the illustrations in Jarvis and Mosby were very similar (both are from Elsevier imprints) or the same, and superior to Bates, which used some unclear photos that looked like they might be left over from standard references of the 1960s. (Bates is now in a new edition, however, with new graphics.) In the cardiac section, I noted that while both Bates and Jarvis cover the same exam and assessment material, Bates is arranged and designed in a way that draws attention to defining distinctions in assessment (how do you rate heart murmurs?) while Jarvis' design highlights the connection between assessment findings and their meaning (a heart murmur may indicate a faulty valve). Again, the skin sections contain mostly the same material with a superiority in graphics and design in the Jarvis book.

The books were so close in content and design that I decided I needed only one. Which did I choose? I considered keeping Jarvis because it was the one I used for school. I considered keeping Bates because it was most different from Jarvis, which I had already read. In the end, I kept none of these three because I discovered that my critical care textbook contains sections on patient assessment that mostly duplicate the material in the health assessment texts.

Critical Care: A Holistic Approach by Morton and Fontaine has pretty much all I need to know about physical assessment to operate in an ICU. In fact, I think it would have been an adequate textbook for almost my entire course of study, useful in the Care of the Adult courses as well as in the health assessment course, all of which required their own textbooks at great expense to the student, who was paying down debts and paying for school out of pocket at the time.