Malaise in medicine: we don't teach what we do

I tested the hypothesis that the most frequently used textbooks of internal medicine are inadequate in their coverage of the evaluation and management of common complaints and management problems of primary care. Fourteen common complaints (symptoms) and nine common management problems (diseases) representing 20% to 40% of primary care patient visits were identified, and seven major textbooks of internal medicine were reviewed to assess the amount and extent of coverage of these topics. The average number of pages devoted to all 14 major problems was about 30, or 1.5% of the total. About 40 (2%) of the pages addressed the nine management problems. The minimal amount of coverage devoted to these topics could be taken as evidence of the lack of respect, importance, and emphasis ascribed to them. The lack of instruction in these areas may enhance malaise in primary car medicine due to inadequate instruction in the needed data base and skills and the resultant patient dissatisfaction.