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August 2013

NeurologistsThe Last Bedside Physician-Scientists

Author Affiliations
  • 1Department of Neurology, University of Kentucky College of Medicine, Lexington.
JAMA Neurol. 2013;70(8):965-966. doi:10.1001/jamaneurol.2013.2977

Over the course of nearly 40 years in medicine, I have had the opportunity to see an evolution in the practice of medicine. As a medical student, I remember that my colleagues and I worked very hard to perfect our bedside diagnostic skills whether it was percussing a chest, discerning differences between the systolic murmurs of aortic stenosis or mitral insufficiency, detecting splenomegaly or an abdominal fluid wave, or examining fingernails for evidence of clubbing or splinter hemorrhages. DeGowin and DeGowin’s Bedside Diagnostic Examination1 was omnipresent in the pockets of our short white coats. In the mid-1970s as a resident in internal medicine, the physical examination skills, hard earned as a medical student, continued to be both refined and expanded. A different but oft overlapping bedside skill set was perfected during my training as a neurologist and has continued to the present day. There is an unsurpassed elegance to the carefully performed neurological examination, which serves as a critical accompaniment to a thorough history. Physicians prided themselves on their ability to detect abnormalities without having to resort to radiographic studies or invasive procedures. Unfortunately, with the exception of the neurologist, the bedside physical diagnostic skills appear to have withered among our colleagues in other disciplines.

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