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  • South African family practice manual, 4/e
  • Mash B, Brits H, Naidoo M, Ras T
  • ISBN: 9780627039799
  • eISBN: N/A
  • ePub ISBN: 9780627039805
  • 840 Pages | Published: 2023

South African Family Practice Manual is a practical text that focuses on the “how to” of working in the district health services. It includes the core skills required of family physicians, which registrars in family medicine need to acquire during their training, as well as additional skills relevant to family practice in different settings. It is also relevant to other clinicians working in district health services, such as medical officers, general practitioners, nurse practitioners and clinical associates, in both primary health care and district hospital environments. The majority of skills are clinical and cover health promotion, disease prevention, therapeutics and interventions, rehabilitation and palliative care for both adults and children. There are also sections that deal with skills related tosupporting community-oriented primary care, clinical training and teaching as well as leadership and clinical governance.

South African Family Practice Manual is a project of the South African Academy of Family Physicians, which is the national professional body for family medicine, and has been a key resource for family medicine training in this country as well as many others across Africa. This fourth edition has three new section editors and a wide variety of new authors to ensure that the content is relevant to the next generation of family physicians. New topics have been added, such as history taking in sexual health, point-of-care ultrasound, helping people with impairments, and mentoring and helping the learner in difficulty. All chapters have been revised to ensure that they are up to date.

South African Family Practice Manual is relevant for medical students, interns, medical officers, registrars, general practitioners and family physicians, as well as nurse practitioners and clinical associates, all of whom will find many of the skills essential to their development and practice.


1. How to communicate effectively in the consultation

2. How to consult a child or adolescent

3. How to take a sexual history

4. How to perform a brief, appropriate neurological examination

5. How to examine the feet of patients with diabetes

6. How to do a rapid musculo-skeletal screening examination

7. How to examine and assess low back pain

8. How to do brief behaviour change counselling

9. How to break bad news

10. How to develop a counselling style

11. How to work with an interpreter

12. How to manage the difficult patient

13. How to assess family structure and resources

14. How to assess family function

15. How to hold a family conference


16. How to support the implementation of community-orientated primary care

17. How to provide support to primary health care teams in your community

18. How to link the primary health care teams to the rest of the health system, other sectors and the community


19. How to do a developmental assessment

20. How to assess growth and classify malnutrition in children

21. How to do childhood immunisation

22. How to administer an intramuscular injection to a child

23. How to do a suprapubic bladder aspiration in a a young child

24. How to get intravenous access in a child

25. How to establish an intraosseous infusion in a child

26. How to perform a lumbar puncture in a child

27. How to assess a child’s chest radiograph

28. How to do a skin test for tuberculosis in a child

29. How to assess and manage child abuse

30. How to use the Road to Health booklet

31. How to do a well newborn check

32. How to assess gestational age at birth

33. How to resuscitate a newborn

34. How to insert an umbilical vein catheter

35. How to establish kangaroo mother care for preterm infants

36. How to manage phototherapy

37. How to use the Integrated Management of Childhood Illness chart booklet


38. How to use the antenatal growth chart

39. How to examine a pregnant woman

40. How to do a single screening ultrasound in pregnancy

41. How to assess foetal wellbeing through its movements

42. How to assess foetal wellbeing during labour

43. How to use a partogram and assess progress of labour

44. How to conduct a normal vaginal delivery

45. How to conduct an assisted vaginal delivery

46. How to do a Caesarean section

47. How to do and suture an episiotomy

48. How to repair a third-degree tear

49. How to remove the placenta manually

50. How to do cervical cancer screening

51. How to insert long-term contraceptive devices:intrauterine contraceptive devices and hormonal implants

52. How to do a minilaparotomy tubal ligation

53. How to do a laparoscopic tubal ligation

54. How to do a medical termination of pregnancy

55. How to do a manual vacuum aspiration

56. How to do a laparotomy for ectopic pregnancy

57. How to do culdocentesis

58. How to treat a Bartholin’s cyst or abscess

59. How to do an endometrial biopsy

60. How to do a paracervical block and remove a cervical polyp

61. How to take care of a sexually assaulted person

62. How to use and implement ESMOE


63. How to perform a lumbar puncture in an adult

64. How to record an electrocardiogram

65. How to interpret an electrocardiogram

66. How to do an exercise electrocardiogram test

67. How to use inhalers and spacers

68. How to do office spirometry

69. How to use a peak expiratory flow meter

70. How to read a chest radiograph

71. How to do a pleural tap

72. How to nebulise a patient

73. How to take blood samples in adults

74. How to give an injection

75. How to interpret a barium swallow


76. How to manage a mental health care user in terms of the Mental Health Care Act

77. How to do a mini mental-state examination

78. How to screen for mental problems

79. How to screen for an alcohol drinking problem


80. How to examine the eye

81. How to treat the eye

82. How to remove a foreign body from the nose

83. How to remove a foreign body from the ear canal

84. How to examine and treat the ear

85. How to examine the mouth and throat, and collect oral and nasal specimens

86. How to do a tonsillectomy

87. How to drain a peritonsillar abscess

88. How to manage epistaxis

89. How to evaluate nasal trauma

90. How to conduct skin prick testing

91. How to do a skin biopsy, cryotherapy and electrotherapy

92. How to excise a sebaceous cyst

93. How to apply a compression bandage for chronic venous ulcers

94. How to partially remove a nail to manage an ingrowing toenail

95. How to treat warts

96. How to approach the care of acute and chronic wounds


97. How to examine for and inject a painful shoulder

98. How to examine for and inject tennis elbow and golfer’s elbow

99. How to examine for and inject De Quervain’s tenosynovitis

100. How to examine for and inject carpal tunnel syndrome

101. How to measure shortening of the legs

102. How to diagnose and inject trochanteric bursitis

103. How to examine, aspirate and inject an inflamed knee

104. How to assess acute ankle injury

105. How to interpret radiographs of arthritic joints

106. How to apply plaster casts and splints

107. How to apply traction

108. How to do closed reduction of common limb fractures

109. How to reduce dislocations of the shoulder, elbow and hip

110. How to aspirate or excise ganglia

111. How to apply a clubfoot cast

112. How to perform an emergency fasciotomy


113. How to do a vasectomy

114. How to do a circumcision

115. How to manage haemorrhoids and perianal haematomas

116. How to read an abdominal radiograph

117. How to do fine-needle aspiration biopsy, a core needle biopsy and excision biopsy

118. How to insert a urinary catheter

119. How to do proctoscopy and sigmoidoscopy

120. How to reduce a paraphimosis

121. How to perform a ring block of the penis

122. How to incise and drain an abscess

123. How to drain or remove a hydrocoele

124. How to interpret an intravenous pyelogram

125. How to perform a lower extremity amputation

126. How to perform an appendectomy


127. How to do a pre-anaesthetic assessment

128. How to administer oxygen

129. How to check the anaesthetic machine

130. How to administer general anaesthesia

131. How to provide inhalational induction of anaesthesia

132. How to monitor a patient during anaesthesia

133. How to monitor a patient recovering from anaesthesia

134. How to administer and reverse muscle relaxants

135. How to administer regional anaesthesia and local blocks

136. How to administer a spinal anaesthetic

137. How to administer procedural sedation and analgesia

138. How to perform ketamine anaesthesia

139. How to decontaminate anaesthetic equipment


140. Algorithms for emergencies

141. How to intubate a patient and manage the airway

142. How to do a cricothyroidotomy

143. How to insert an intercostal drain

144. How to relieve a tension pneumothorax

145. How to insert a central venous line

146. How to relieve a cardiac tamponade

147. Transcutaneous cardiac pacing

148. How to do a primary survey

149. How to do a secondary survey

150. How to obtain an arterial blood sample

151. How to do a point of care ultrasound

152. How to insert a nasogastric tube

153. How to give a blood transfusion

154. How to measure the Glasgow Coma Scale

155. How to interpret X-rays in a trauma patient

156. How to calculate the percentage of burn

157. How to manage poisoning or toxic exposure

158. How to restrict spinal motion

159. How to transport a critically ill patient from primary to secondary care

160. How to remove percutaneous foreign bodies

161. How to suture a laceration

162. How to debride a wound


163. Approach to assessing disability and rehabilitation

164. How to assess a patient requesting a disability grant

165. The role of the family physician in the rehabilitation of a stroke patient

166. A structured approach to coordinating the care of people and families with cerebral palsy

167. How to care for a person with spinal cord affliction

168. How to care for amputees


169. How to care for the dying patient and communicate with the patient and family

170. The use of syringe drivers to deliver continuous subcutaneous infusions in palliative care

171. How to assess pain


172. How to keep a patient’s medical records

173. How to notify a death

174. How to fill in a certificate of illness

175. How to notify a medical condition

176. How to refer and discharge a patient

177. How to assess fitness for driving at work

178. How to claim compensation for work-related injuries or diseases

179. How to complete a J88 form for an assault case and prepare for an appearance in court

180. How to assess drunk driving and the responsibilities of the doctor


181. How to establish an effective learning environment

182. How to to use a portfolio of learning

183. How to plan and implement a teaching activity

184. How to have effective learning encounters in the workplace

185. How to facilitate small-group learning

186. How to prepare a presentation

187. How to mentor a colleague

188. How to recognise and help the learner in difficulty


189. How to audit and improve the quality of your service

190. How to take on leadership roles and initiate teamwork

191. How to organise and run morbidity and mortality meetings

192. How to deal with a medical mistake

193. How to manage the impaired health practitioner or colleague

194. How to enable resilience and avoid burnout

This review originally appeared in the African Journal of Primary Health Care & Family Medicine

This revised edition of the South African Family Practitioner's Manual, first published in 1995, is a huge contribution to the field of family practice not only in South Africa but also in many middle-and low-income countries particularly in Africa. The editor Bob Mash has widened his editorial team to manage a remarkable 194 chapters, covering a vast array of practical skills. The range of topics covered by the chapters illustrates the extremely wide scope of practice demanded of generalists, which goes far beyond the manual skills of specific procedures, including: (1) communication, (2) working with interpreters, (3) engaging with communities, (4) teaching and dealing with resilience and (5) burnout, for example. So, as far as comprehensiveness is concerned, the manual is impressive and clearly delineates the role of the generalist practitioner in the South African context.

 The list of authors is extremely diverse, with not only family physicians and general practitioners but also specialists from a wide variety of disciplines, including public health, anaesthetics, even plastic surgery and radiation oncology. Many of the emergency skills lie squarely in the domain of the developing specialty of Emergency Medicine, with which Family Medicine has a close relationship in South Africa, and which is fast developing in other countries. While there needs to be overlap, the differentiation of the specialties is important, and this manual helps to specify the skills that are in common as well as those that are more appropriate to generalist practice.

Despite the chapters on family and community engagement, the broad framing of the skills required of the generalist medical practitioner is still too biomedical and curative oriented, with not enough emphasis on health promotion and how to address the social determinants of health that drive the burden of disease. The only issue that, the author feels, does not receive appropriate attention is that of leadership, teamwork and referrals to other levels of care, although it is mentioned as important in several chapters, particularly the community-oriented and rehabilitation chapters. Tackling the social determinants of health demands a structured team approach, and the role of the medical practitioner needs to be negotiated, as it is not necessarily that of the leader, especially at the community level. How best to contribute to the wider systems that concern health, is a high-level skill required of the medical practitioner that possibly requires a separate chapter in the future.

The book is very well laid out, with clear writing and extensive diagrams and images in most chapters. The chapters are succinct and to the point, to the extent of being not detailed enough in some instances, where other resources would need to be consulted before attempting a particular procedure (e.g. Chapter 46 – How to do a Caesarian section). Nevertheless, most chapters offer a good introduction to each procedure, and the bibliography at the end of the book gives some guidance to further reading. This could be enhanced by the inclusion of two or three key references at the end of each chapter, for those interested in taking it further.

The manual deserves to be on the desk of every career generalist practitioner in Africa, from clinical associates or officers, to medical officers, general practitioners and family physicians. Particularly in rural hospitals and health centres, where specialist advice or supervision is not immediately available, the manual fulfils the crucial function of giving practitioners an entry point into the wide range of practical skills demanded of the generalist, which at first appears to be overwhelming to the young community service officer. Having this book at each district hospital in the country should go a long way to mitigating that anxiety.

Reid S. Book Review of South African Family Practice Manual: 4th edition. Afr J Prm Health Care Fam Med. 2023;15(1), a4207.

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