This book of cases with
multiple-choice questions is aimed at medical students in the US who have to
take the Step 2 & 3 USMLE and who have to go on psychiatric rotations.  Since I’ve never been to medical school, and
I’ve never taken those exams, or even seen them, I am not really able to assess
whether the book would be useful to those students.  However, it is a useful book for anyone wanting to learn about
contemporary psychiatry.  It consists of
50 cases.  Each case starts with a brief
description of the initial information from the patient, a medical history, family
history, social circumstances, and lab work. 
Many of the cases include thought questions, that should help patients
to think about the case more clearly, and there are some definitions and
explanations of terms included with the cases. 
The cases make frequent use of abbreviations, and there is a helpful
list of abbreviations at the start of the book.  Each case finishes with four multiple-choice questions, and at
the end of the book are answers to those questions with brief explanations of
why one of the responses if right and why the remaining ones do not fit.

The test questions could be better
formulated.  One obvious problem is the
answer is D in a disproportionately large number of the questions, and well-set
questions should not favor any particular answer.  More problematic is that some of the possible answers are phrased
in misleading ways.  For example,
question 125 asks about the legal aspects of patients’ capacity to make
decisions concerning their treatment. 
The answer the book gives is that "Competence is decided by the
court."  Apart being vague about
which court, it is also ambiguous about whether it means competence is always
or sometimes decided by the court, or whether it should always be decided by
the court.  Of course, in most cases,
doctors agree with the decisions their patient makes and they don’t have any strong
reason to doubt their patient’s competence, do it never goes to court.  A court normally only gets involved if the
doctors believe that a patient should receive treatment but the patient
refuses, and the doctors are not able to convince, cajole or coerce the patient
into accepting treatment.  In many
actual cases, if a patient’s physician is not sure whether a patient is
competent, and asks a psychiatrist to evaluate the patient, and the
psychiatrist decides the patient is competent, the case never actually goes to
court.  This is just one example, about
which I happen to have some knowledge about the topic and so I’m able to assess
the answer.  However, many of the test questions
have similar problems with them.  This
is not a major problem with the book, though, so long as those using it make
sure they understand the longer answers given at the back. 

One might also argue that the short
case histories don’t provide enough information for readers to really
understand the cases.  However, in my
(limited) experience observing psychiatrists communicating with each other
about patients, these cases contain about as much information as professionals
would give each other, at least when first discussing a case.  Longer case discussions are probably more
appropriate when more specialized learning, but these short descriptions are
appropriate for students getting clear on the basic facts of psychiatry. 

So this is a useful book for people
wanting to test themselves on their basic psychiatric knowledge. 

© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy
Department at Dowling College, Long Island, and editor of Metapsychology
Online Review.  His main research is on philosophical issues in
medicine, psychiatry and psychology.

Categories: MentalHealth