The journey of a medical book – from concept to completion….

Book Binding

Weekend Book Binding. Photo: Nate Steiner. Used under CreativeCommons.

Since our book has been published, colleagues, friends and family have been intrigued as to our journey to publication. For us, it is immensely satisfying to see, and feel, the final product. It is also a good time for us to reflect on how we got here…


As with many of these things, the book’s concept was spawned during a chance conversation between operating theatre lists. We were colleagues at a busy DGH and in the midst of our FRCA exams – Ned lining up for the primary written, and Marc for the final written. ‘Wouldn’t it be great,’ Ned mused, ‘if there was one book where all the equations for the exams were collated, explained and made sense of’. A quick Google search revealed no such texts, and thus we returned to our revision relying on the time-honoured tradition of thumbing through dog-eared text books and trusting our sage superiors’ tuition. This initial conversation had however planted somewhat of a seed for an idea and following a quick straw poll of our colleagues, we surmised that equations were one of the aspects that really exorcised FRCA candidates.


The next stage was to articulate our thoughts, and we decided that the best way to do this was to use a publisher’s guidelines. Having both used, and been thoroughly impressed with Cross & Plunketts’ Physics, Pharmacology and Physiology for Anaesthetists, we approached Cambridge University Press (CUP) with the opinion that our text could be a natural bed-fellow to said text.

Having browsed the FRCA curriculum, and documented every equation we came across in our revision texts, we collated the list of all the equations encountered, wrote a number of example chapters, and submitted our book proposal to CUP. A swift and very positive peer review ensued, and we were delighted, though somewhat surprised to have our idea accepted.

One important caveat had been proposed, the suggestion that we used a well-established senior colleague to both edit the text, and mentor us through the writing stages. One such colleague independently sprung to both our minds, Dr Wynne Davies. Having both worked under Wynne’s clinical guidance, his immense knowledge and ever enthusiastic willingness to teach made him the ideal candidate. This was bolstered further as Wynne had also previously been an examiner for the Royal College of Anaesthetists, such that he was ideally placed to provide ideas and opinions from ‘the other side of the table’. Thankfully he accepted, and we are both extremely grateful for all the hard work, mentorship and friendship that he has provided us with over the months of writing.


With the proposal accepted and contracts signed, the hard work started. The submission deadline clock had started ticking, with completion some 18 months away. Our approach to writing was to do quasi peer-review. Together we formatted a page template, decided on the format of each chapter, and subsequently divided the topics and started writing. Dropbox (other internet clouds are available) was used to store the drafted pages, thus enabling the other author (Marc for Ned, Ned for Marc) to review and edit each person’s initial endeavours. Following the undertaking of these preliminary corrections, Wynne edited each page in turn, before once again returning each to us for universal approval.

Ensuring accuracy was a top priority, as was making the book readable, relevant and clear. Arguably the most time consuming part of writing was providing the applications of each equation to clinical practice. However, this, apart from having all the equations necessary for the examinations in one place, is what we feel that the USP of our book is. Knowing the equations is one thing; understanding them and being able to derive them another. Being able to apply the equations to medical and anaesthetic practice is vital in order to negotiate the examinations, particular the oral ones, and also arguably to stay sane whilst revising and questioning the need to learn and memorise some rather obtuse concepts.

Once the text was prepared and bounced between us until we were happy with it, we sent it to Cambridge University Press for proof-reading and type-setting. It was fascinating to be involved in these processes and again, an eye for detail was mandatory. We also had our non-anaesthetist partners look over it which was invaluable.

At last the text was ready and we waited in anticipation for the final product: it was a great feeling of satisfaction when it fell through the letterbox and made all the hard work worthwhile.


Whilst neither of us were deluded enough to think that writing a book would be easy, one should certainly not underestimate the amount of time, effort and sacrifice required. Writing, reading, editing and re-revising comments was somewhat time consuming, especially alongside a PhD (Ned), and HEMS & NHS England Fellowship (Marc).

Moving forwards, we eagerly await peoples’ feedback. Undoubtedly as medicine and anaesthetics progresses, there will be corrections and clarifications required in future editions. We very much hope that readers will enjoy it and find it useful and we would welcome any comments and feedback.

In the book, we have tried hard, and hopefully succeeded in the majority of cases to tick all the boxes which will give readers a head start, whether they are preparing for the examinations themselves, helping others to do so, or even, dare we say it, examining!

Top tips amassed from 18 months of toil…

  1. Know your audience and write for them, not you.
  2. Choose a mentor that you trust and can reply on.
  3. Know your market and spot the gaps. They may be very obvious such that one assumes someone else has already filled them.
  4. Don’t underestimate the amount of work involved, and ensure that your nearest and dearest are supportive of your project!
  5. Detail, detail, detail…edit, edit, edit.

Dr Marc Wittenberg and Dr Edward Gilbert-Kawai are co-authors of Essential Equations for Anaesthesia (out now).

Essential Equations for Anaesthesia



So what causes AUB-O?

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

In the reproductive years, many women with abnormal uterine bleeding (AUB) have a disorder of ovulation – a group of entities designated “AUB-O” in the new FIGO classification system for causes of AUB in the reproductive years.(1) But what are these ovulatory disorders, and how are they diagnosed and treated?

The only thing “typical” about women with ovulatory disorders is that they do not have the characteristics of normal ovulation – ie predictable menstrual bleeding, with a reliable cycle length of 22 to 35 days and duration and flow that is consistent from period to period.(2) Instead, these women are often plagued with uncertainty – uncertainty about the time of onset, and, frequently, the volume and duration of bleeding.  Read more of this post

The changing world of vascular surgery

Blog Post by Mr Vish Bhattacharya MB BS, FRCS (Glas & Edin), FRCS (Gen Surg) Consultant General and Vascular Surgeon, Queen Elizabeth Hospital, Gateshead, UK.

Vascular surgery has changed dramatically over the last 10 years. The major emphasis has been on prevention of vascular disease and on minimally invasive surgery. There has been much better awareness among the general body of doctors especially GPs about arterial disease and their management. Early detection of peripheral arterial disease and its management is gaining increased importance in order to reduce the number of amputations.

Venous disease management has also changed and less invasive forms of treatment for example foam sclerotherapy, radiofrequency ablation and laser treatment of veins have emerged. Read more of this post

Acute heavy menstrual bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Recently a young healthy woman presented with acute heavy menstrual bleeding (HMB) and was placed on a multidose combination estrogen-progestin oral contraceptive (COC) regimen. As the bleeding stopped she developed central neurological symptoms and findings and was diagnosed with internal jugular venous thrombosis that resulted in profound neurological sequellae. Investigation identified the presence of a previously undiagnosed case of von Leiden factor deficiency. This case provides a suitable backdrop for discussion about acute heavy uterine bleeding, the role for medical therapy, and the potential consequences of high dose estrogenic interventions.

The entity of acute HMB has only recently been defined as heavy uterine flow not associated with pregnancy that is of sufficient volume to require urgent or emergent medical intervention.1  Although research evaluating the causes of this recently defined entity is necessary, it is likely that ovulatory disorders (AUB-O) are the most common cause. However, coagulopathies may also contribute (AUB-C), and, particularly in adolescents with von Willebrand disease, may augment the heavy bleeding associated with perimeharcheal anovulation (AUB-C, -O). Arteriovenous malformations are yet another but admittedly rare entity that can also cause acute HMB. Read more of this post

Quality of life measurement in neurodegenerative and related conditions

Blog post by Crispin Jenkinson, Professor of Health Services Research, Department of Public Health, University of Oxford, and Senior Research Fellow, Harris Manchester College, Oxford, and Michele Peters, Research Officer,  Health Services Research Unit, Department of Public Health, University of Oxford

Patient reported outcome measures (PROMs) are questionnaires that ask people questions about their current health. PROMs assess or measure patients’ quality of life, or what is sometimes referred to as health-related quality of life. Two types of PROMs exists: generic and disease-specific. Generic PROMs can be used across a broad range of diseases as well as the general population; whereas disease-specific PROMs are designed to be used in a specific patient group. Disease-specific instruments are generally regarded as potentially both more precise and sensitive to changes than more generic measures because they are intended to reflect the particular demands of specific conditions. However, generic measures allow comparing health status of (disease) groups to population norms and between disease groups. Read more of this post

Delirium as a Cause of Violent Behavior

Blog Post by James J. Amos MD, University of Iowa, USA

Another reason why it would important to prevent delirium is the risk for violence patients can have for themselves and others. Patients who would not otherwise be violent can sometimes become violent when exposed to medications with which they’re unfamiliar. One combination of drugs that most people tolerate well but which can provoke intoxication delirium in others is Versed and Fantanyl. Versed is a sedative-hypnotic in the benzodiazepine class (Valium is in the same class) and Fentanyl is an opioid pain killer. Demerol is another opioid pain-killer that is a well-recognized cause of delirium.

These medications are often used on outpatient minor surgical procedures to produce sedation and analgesia. Occasionally, the relaxed and pain-free states they produce can cause an altered mental state that make people appear as though they’ve been on an all-night bender on alcohol.

Read more of this post

What can be done about the poor state of global health?

Blog Post By Solomon Benatar, University of Cape Town & Gillian Brock Department of Philosophy, University of Auckland

What can be done about the poor state of global health? How are global health challenges linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? These questions are addressed from the perspective of medicine, philosophy and the social sciences. Offering a wealth of empirical data and both practical and theoretical guidance, this is a key resource for bioethicists, public health practitioners, and philosophers. Read more of this post

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