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By Luigi E. Picasso

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2, 3): References: 1. Osler W (1892) The principles and practice of medicine: designed for the use of practitioners and students of medicine. D. 1 General Textbooks on the Needed Knowledge 23 2. Colledge NR, Walker BR, Ralston SH (eds) (2010) Davidson’s principles and practice of medicine, 21st edn. Churchill Livingstone, Edinburgh 3. Goldman L, Ausiello D (eds) (2008) Cecil Medicine, 23rd edn. Saunders/ Elsevier, Philadelphia Osler’s book – a true classic in medicine – has no Introduction or Preface, nor does it elsewhere explicate the duality in its title constituted by the principles of medicine on one hand and the practice of medicine on the other hand; but implied by its title is that the book is about both of these two aspects of medicine, and that it is to be used both as a textbook in the study of medicine and as a handbook in the practice of medicine, the unitary discipline of medicine.

The Cecil textbook (ref. 3 above) is substantially more extensive than Davidson’s, consisting of almost 3,000 pages. It does have a Preface, and in it the Editors say this as the essential introduction to the book: The 23rd Edition of the Cecil Medicine . . [represents] the latest medical knowledge . . The contents of Cecil have remained true to the tradition of comprehensive textbook of medicine that carefully explains the why (the underlying normal physiology and pathophysiology of disease, now at the cellular and molecular as well as the organ level) and the how (now frequently based on Grade A evidence from randomized controlled trials).

It is formulated in the spirit of viewing the challenge in the context of a CP presentation to be, simply, discrimination between MI and its absence, when the true challenge is discrimination among all of the illnesses in the differential-diagnostic set. Whereas that model has an indicator for the CP being more-or-less typical of MI (substernal ‘aching’ or ‘pressure’), it should, in the same vein, have an indicator for the CP being more-or-less typical of gastroesophageal reflux (substernal ‘burning’), for example.

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