am a physician who has used Washington manuals for many years. I must say that the current edition has changed in ways that make it NOT a manual. This thing is over 1000 pages. It still gives one the practical step by step description of how to correct hypokalemia or how to manage ketoacidosis. It is still in there most of the time but the current manual tries to be a short textbook of medicine with a lot of pathophysiology. I enjoy pathophysiology but that is not why I bought the manual. The practical stuff is harder to find and should be moved to the front of each section rather than the end. It is sometimes missing from the end and that is a comment on the editorial oversight. The current Washington manual is evolving toward the Merck manual a somewhat defunct text. I can not imagine carrying this book around in my bag or pocket because of it size and weight. I suppose I will be subscribing to some web resource for my smart phone in the future.