|  It is hard to begin to even gauge how much a complication of possessions, the notions of “my and mine,” stand between us and a true, clear, liberated way of seeing the world. To live lightly on the earth, to be aware and alive, to be free of egotism, to be in contact with plants and animals, starts with simple concrete acts. The inner principle is the insight that we are interdependent energy-fields of great potential wisdom and compassion – expressed in each person as a superb mind, a handsome and complex body, and the almost magical capacity of language. To these potentials and capacities, “owning things” can add nothing of authenticity.
— Gary Snyder Sometimes it is helpful to go beyond the basic assessment techniques given in the usual first response texts. The following books go into patient assessment and diagnosis – including interviews, history, and physical examination – in considerably more detail. There seem to be two types of assessment texts: there are thick heavy comprehensive texts, primarily for training first- and second-year medical students; and there are brief focused texts for people who have to make quick decisions, such as EMTs and nurses. If we take the titles of these texts seriously, we might conclude – probably with some accuracy – that EMTs have sixty seconds to make a patient assessment, nurses have ten minutes, and doctors have as much time as they want.
 American Academy of Orthopedic Surgeons, Sick Not Sick: A Guide to Rapid Patient Assessment (Sudbury MA: Jones and Bartlett Publishers, 2000), ISBN 0-7637-1191-8. This book attempts to provide tools for answering a basic question when responding to an emergency: could this person die within the next fifteen to twenty minutes? The text lays out a procedure for deciding whether a patient is, as the title says, sick or not sick – that is, whether the patient is physiologically unstable or not, and thus whether the patient requires aggressive action and immediate transport. The procedure focuses on the most important clinical indicators and the formation of a quick and accurate initial impression or clinical picture. The book has a special section on pediatric assessment, and numerous medical, trauma, and pediatric case studies.
 Gideon Bosker, et al., The 60-Second EMT: Rapid BLS/ALS Assessment, Diagnosis & Triage (St. Louis MO: Mosby Lifeline, 1996), ISBN 0-8016-7812-9. This is a well-known and perennially best-selling little text for EMTs and paramedics, engagingly written in narrative form and containing conceptual approaches, checklists, and lots of mnemonics for rapid street diagnosis of medical emergencies. It provides 60-second assessments of chest pain, syncope, multiple trauma, coma, thermoregulatory disorders, and acute abdomen; 60-second toxicology exams, respiratory exams, neurologic exams, pediatric and geriatric assessments, and – extremely helpful – how to do a 60-second presentation to the Emergency Room nurse.
 Mark A. Davis, Signs & Symptoms in Emergency Medicine: Literature-Based Guide to Emergent Conditions (St. Louis MO: Mosby-Year Book, 1999), ISBN 0-32300-211-0. This is a pocket-sized – well, as pocket-sized as you can get at more than 500 pages – quick reference providing a symptom-based approach to emergency care, organized by presenting symptom rather than by organ system or disease. So, when someone has a headache, say, or abdominal pain, change in mental status, vaginal bleeding, nausea and vomiting, vertigo, or fever, you look up the particular sign or symptom, and the text provides the conditions – more than 200 in all – that should be considered in the patient assessment, along with workup and treatment considerations for each diagnosis. It has both halftone and color illustrations, presents information in an outline format for fast access, and includes key references to the medical literature with each diagnosis.
 Stanley Loeb, et al., Rapid Assessment (Springhouse PA: Springhouse Corporation, 1991), ISBN 0-87434-364-X. What the comprehensive assessment textbooks don’t teach is how to perform a quick assessment of a particular complaint – “My chest hurts,” “I can’t breathe,” “My stomach’s killing me.” This book is an assessment and diagnosis manual for nurses, who often must make quick decisions without the luxury of a complete system-by-system examination. It contains basic practical instructions for quick assessments – touch here, don’t forget to look there, ask the patient about that. It covers assessments of the head and neck, chest, abdomen, and extremities, with pencil sketches, listings of normal findings, step-by-step instructions, and helpful charts setting out the chief complaint and abnormal findings, nursing diagnostic categories, and probable cause.
 Mosby's Expert 10-Minute Physical Examinations (St. Louis MO: Mosby, 1997), ISBN 0-8151-2039-7. While doctors do comprehensive exams, nurses have to figure out quickly why you are having chest pains. This book was compiled by a team of nurses to facilitate quick and accurate assessments of a problem – a chief complaint – in a particular part of the body. Thus it provides signs and symptoms of common disorders, tables linking physical findings with possible causes, priority checklists, normal assessment results, tips for quickly assessing life-threatening problems, detailed anatomical drawings, disorder close-ups, examination tips, and step-by-step instructions for assessment tests. The book is organized by body regions and chief complaints, with each chapter setting out the examination procedures and findings, both normal and abnormal, and presenting problems and probable causes.
 Henry M Seidel, Mosby's Guide to Physical Examination (St. Louis MO: Mosby-Year Book, 5th edition, 2002), ISBN: 0-32301-680-4. Written by a team of two physicians and two nurses, this comprehensive textbook of physical examination, history taking, and health assessment is intended to teach basic physical examination skills to beginners in all the various medical disciplines – nursing, medical, chiropractic, and allied health. This collaboration yields a broad perspective, a patient-centered approach, and an emphasis on assessment throughout the lifespan: each chapter includes approaches and techniques relevant to infants, children, adolescents, older adults, and pregnant women. More than 1000 pages long, the work is filled with tables, charts, and high-quality illustrations of both normal and abnormal physical findings. The text stresses the importance of patient rapport and the need to incorporate an understanding of cultural diversity into the history-taking process. Each chapter includes a review of anatomy and physiology, pertinent health history considerations, and common abnormalities associated with each body system. Because of its focus on teaching skills to beginners, the book has a helpful emphasis on normal anatomical variants, useful mnemonics, how to record information, and how to put the examination pieces together into an assessment.
 Mark Swartz, Textbook of Physical Diagnosis: History and Examination (London UK: W.B. Saunders, 4th edition, 2001), ISBN 0-72169-411-X. This is a comprehensive text for medical students learning physical diagnosis, more than 800 pages long, organized by organ system. What I particularly like about this text is its humanistic approach; as one reviewer put it, the book treats the patient as a person suffering from a disease, rather than as an entity in which a disease manifests. For example, the section on patient interviewing includes an entire chapter on cultural issues; the chapters on examination techniques discuss not just the relevant anatomy, physiology, and symptomatology, as well as the physical examination techniques themselves, but also the impact of disease on patients. The book also has chapters on nutrition and on clinical epidemiology. It has over 500 illustrations and photos – color for patients and problems, black and white for basic diagnostic techniques; it comes with a CD-ROM which includes a video demonstration of the complete physical examination of a man and the breast and pelvic examinations of a woman.
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