Marshall and Ruedy’s On Call: Principals and Protocols

By Peter Leggat In   Issue Volume 16 No. 4 .

Mike Cadogan, Anthony FT Brown and Antonio Celenza*

*1st edn, xvi + 576 pp, paperback with illustrations, ISBN 978-0-7295-3803-9. Sydney, Saunders (Imprint of Elsevier), RRP: $63.50, 2007.

The Australian Institute of Health and Welfare define ‘on call’ as “the number of hours in a week that a medical practitioner is required to be available to provide advice, respond to emergencies, etc”1. According to the Australian Medical Association’s Safe Hours Audit 20062, which was based on a survey of all doctors employed in public hospitals, in addition to their normal shift and overtime hours about one third of doctors were on call for one or two days per week and about one-fifth were on call for three or more days per week. It is also known that doctors outside the hospital invest many hours on call each week. So it is timely that an Australian version of well-known American title, On Call: Principles and Protocols,3 has finally been produced. The 1st Australian edition of Marshall and Ruedy’s On Call: Principles and Protocols will no doubt establish itself as one of the leading reference manuals in Australasia for those who are embarking on their medical careers involving ‘on call’ in most cases.

Marshall and Ruedy’s On Call is presented as a 576-page A5 publication that would fit easily into the briefcase or carry bag. It contains a preface, table of contents, a section about the authors, acknowledgements, a list of abbreviations, six sections, 66 sub-sections and a comprehensive index. There is no foreword, bibliography, glossary, or appendices. The absence of a foreword is probably a marketing opportunity missed, especially in a first edition, even though it is an Australian makeover of an American title by the same name. <!–[endif]–>

The primary target audience of Marshall and Ruedy’s On Call is stated to be “junior doctors and senior medical students” in the Australian setting, given that it contains Australian guidelines and protocols. It would also be a useful resource for trainee general practitioners, rural and remote medical practitioners and other doctors who do on call in other settings, such as with private hospitals, defence and similar organisations. Any doctor who has limited experience on call or is on call only occasionally will find this a useful reference. This book should certainly be on the recommended textbook lists for senior medical students, interns and hospital residents.

The sections include “Section A – General Principles”; “Section B – Emergency Calls”; “Section C – Common Calls”; “”; “Section D – Interpretation of Common Investigations”; “Section E – Practical Procedures” and “Section F – Formulary”. By far the largest section at approximately 250 pages is “Section C”, which discusses a virtual A to Z of major presenting syndromes or sub-sections from “Abdominal Pain” to Weakness, Fatigue and Dizziness. It is a pity they are not presented in alphabetical order, but they are probably in order of common presentation. It is not just a theoretical manual, but a practical one, particularly with the inclusion of a whole section devoted to “Practical Procedures” (Section E) with most of the common procedures covered, which can be a useful refresher for those that might not have done the procedure for some time or have limited experience.

Marshall and Ruedy’s On Call is primarily tailored for the Australian environment and hence it will have limited application outside Australia.Doctors will need to be conversant with local clinical guidelines and policies and the availability of tests, procedures and pharmaceutical agents. For this reason, it will also have limited use for those working in developing countries where tropical diseases may be prevalent. Although individual tropical diseases are not mentioned in the index, a number of syndromic presentations do mention some of these, such as malaria, and the need to ask for a history of overseas travel in a patient with fever (p 306). Travel related conditions will be important for those working in defence establishments, as well as in public hospitals and in private practice. Cardiopulmonary resuscitation is discussed under “Cardiac Arrest” (Sub-section 8); however it may be useful to include a ready reference chart on the inside front or back cover, so it can be found quickly. Although acute psychiatry is not well covered beyond “Altered  Mental State” (sub-section 20), there is a useful paragraph on psychiatric evaluation (p 183). The other area that may need an additional Australian text, such as one reviewed previously for this journal,4 is the area of toxicology and envenomation.

Brief details of the three authors are given on the back cover as well as brief profiles in the About the Authors section (p ix-x). The authors would be fairly well known in Australasia. Michael D Cadogen is Clinical Senior Lecturer in the Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, and Staff Specialist in Emergency Medicine, Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth. Anthony FT Brown is Associate Professor, Discipline of Anaesthesiology and Critical Care, School of Medicine, University of Queensland, and Senior Staff Specialist, Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane. Tony Celenza, is Associate Professor in the Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, and Staff Specialist in Emergency Medicine, Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth.

The logical and concise style ensures that Marshall and Ruedy’s On Call is easy to read. Although only the first Australian edition, Marshall and Ruedy’s On Call is a remarkably mature reference manual, most likely due to the fact that it is an adaptation of a popular reference in America, but none-the-less, its comprehensiveness is a credit to the authors. Marshall and Ruedy’s On Call has little competition nationally in ‘on call’ medicine, but there are quite a few definitive general and emergency medicine textbooks and manuals around. Clearly, this manual is not a substitute for adequate training and textbooks in ‘on call’, general medicine or emergency medicine, but Marshall and Ruedy’s On Call will certainly appeal as a useful adjunctive text to the training of junior hospital staff and senior medical students in Australasia. The cost is not prohibitive for clinicians and Marshall and Ruedy’s On Call is sure to become an important addition to the exclusive international portfolio of standard manuals and textbooks in the area of ‘on call’ and emergency medicine.

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1.   Australian Institute of Health and Welfare. Medical Practitioner-hours on call: identifying and definitional attributes. URL. (accessed 27 May 2008) 2.   Australian Medical Association. AMA Safe Hours Audit 2006. Kingston, ACT: AMA, October 2006. URL.$file/Safe_Hours_Report.pdf (accessed 27 May 2008) 3.   Marshall S, Ruedy J. On Call: Principles and Protocols. 4th edn. Philadelphia: Saunders (Imprint of Elsevier), 2004. 4.    Murray L, Daly F, Little M, Cadogan M. Toxicology Handbook. 1st edn. Sydney: Churchill Livingstone (Imprint of Elsevier), 2007 (Reviewed J Mil Veterans’ Health 2008; 16(3): 34-35.)