The worth of a book is to be measured by what you can 
carry away from it

James Bryce

“Life would be much simpler for General Practitioners (GPs) if patients presented with a diagnosis. Unfortunately, 
patients present with symptoms that are frequently 
vague, sometimes multiple and often obscure” is 
an often repeated statement in the book. It is this 
situation which first prompted the authors to write 
this book which has become so popular that it is 

already in its fourth edition.
There is a gap between how medicine is 

taught and practised. The focus in teaching on the 
biomechanical model together with the current 
advances in technology are replacing the crucial 
tasks of history taking and examination with 
more and more investigations. The importance of 
symptoms in making decisions about diagnosis is 
being whittled away.

This book is a pleasure to read because of its 
contents and the way they are presented, each 
symptom described in brief and to the point 
sections of bulleted points. It helps to make sense of 
100 or so symptoms with which patients commonly 
present to the family physician (FP). It is written 
by two GPs in UK and primarily targeted at GPs at 
all levels of training and experience, as a source of 
rapid reference.

Each chapter in the book addresses a symptom 
under the headings of: GP Overview, Differential 
Diagnosis (further subdivided into Common, 
Occasional and Rare), Ready Reckoner, Possible 
Investigations (categorised into Likely, Possible and 
Small print), Top Tips and Red Flags. Each symptom 
chapter could be reviewed in less than five minutes.

To test this book, we tried it out in a real life 
situation. A 37 year-old lady presented to a FP with 
a history of three episodes of dizziness since that 
morning; they were self limiting and lasted for 
about 3–5 minutes each. She was worried because 
she had been operated on for coarctation of the 
aorta 12 years ago, had then had angioplasty 6 years 
later and an ablation done last year. She was being 
followed up by the cardiologist. On examination 
she was apparently healthy, not distressed, 

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

BOOK REVIEW

Symptom Sorter
Authors: Keith Hopcroft and Vincent Forte

Publishers: Radcliffe Publishing, 4th Edition, 2010
ISBN: 13:978 1 84619 4535

Orders: www.radcliffe-oxford.com

SQU Med J, May 2011, Vol. 11, Iss. 2, pp. 293-294, Epub. 15th May 11
Submitted - 16th Feb 11



Symptom Sorter

294 | SQU Medical Journal, May 2011, Volume 11, Issue 2

haemodynamically stable with a pulse of 68, regular, 
normal volume and blood pressure of 130/70 
mmHg. The systemic exam was non-contributory. 
The FP was faced with the challenge of a familiar 
symptom in an unfamiliar territory. Referring to 
the book, I found a chapter on dizziness and had 
a quick glance at the list of differential diagnosis 
to identify possible reasons such as viral illnesses, 
postural hypotension and arrhythmias. A review 
of the section on red flags excluded any urgent 
condition. The patient was discharged with advice 
to follow up after three days or sooner, and that 
if the symptoms worsened she should go to the 
Emergency Department. 

The above example demonstrates the usefulness 
of this book and justifies the “Highly Commended” 
recommendation by the British Medical Association 
Book Awards in both 2004 (2nd edition) and 2008 
(3rd edition). 

What I would like to see in the future edition of 
this book is, first, that it be available in electronic 
format and, second, that it would give the likelihood 
ratios of various symptoms so that it becomes a 
more ‘evidence-based’ book.

In summary, this is a book worth having 
available at the point of care for health professionals, 
including doctors, nurses, undergraduates and 
postgraduates, to help them make sense of common 
symptoms. With the help of the authors’ opinions 
in combination with our own experience we should 
then, as health care professionals, be able to make 
better clinical decisions.

r e v i e w e r

Kamlesh Bhargava
Department of Family Medicine & Public Health
Sultan Qaboos University Hospital, Muscat, Oman
Email: drkamlesh@gmail.com