The need to hear and record the patient's history, and to elicit and interpret physical signs remains paramount in medical practice. In an era of increasing medical litigation, accurate records of history and examination in hospital and general practice serve to strengthen the defence of the doctor. Recent changes in medical education are directed to problem-solving techniques, which rely on evidence-based medicine that require access to a computer. However, we still believe that comprehensive texts, illustrated with contemporary disease states, will remain a valuable source of clinical instruction for students and qualified medical staff.
A lot of tables have been introduced for ease of learning and understanding, while photographs - some black and white, some in colour will help to understand descriptions of practical skills and physical signs. We are grateful to all the patients illustrated who have consented to their photographs being published in this edition.
The authors wish to thank the many colleagues and friends who have been instrumental in the preparation of this book. To the staffs of the Chair and Clinic of internal diseases propedeutics, Sechenov Moscow medical academy goes our gratitude for their assistance in preparing illustrations used in this book. We express our special thanks to doctors Maria Nadinskaya MD, Oxana Drapkina MD PhD, Julia Shulpekova MD, Oleg Shifrin MD, Alexey Lapshin MD, Chavar Pavlov MD, Mikhail Kon'kov, Natalya Kokina MD, Marina May-evskaya MD, Alexander Rumyantsev, Yan Libet, Lar-isa Sheptulina.
We have been interested for some years in the difficulties encountered by medical students in understand-
ing these fundamental principles with regard to physical examination. By whatever method they are taught, the apparent ease with which these principles are forgotten (or not learned) impels serious thought as to the efficacy of teaching methods. It is indeed a source of wonder that students will memorize and retain facts concerning difficult differential diagnosis, multiple details with regard to clinical pictures and therapeutics and yet are unable, beyond the period of formal examination, to retain the fundamental facts about physical examination.