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Comment & Response
January 2014

Neurologists as Physician-Scientists

Author Affiliations
  • 1Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
JAMA Neurol. 2014;71(1):113. doi:10.1001/jamaneurol.2013.4813

To the Editor I read with interest Dr Berger’s Viewpoint1 on the neurologist as the last still-standing (proudly, I would say) physician scientist. He rightly pointed out that some of us still spend time getting a thorough history, formulating a differential diagnosis, and then relying on our examination skills to help localize the lesion to the correct level of the neural axis. The operational word though is some. Like our colleagues in other medical specialties, we too are getting slowly, but surely, corroded to take the easier path—do a cursory neurological examination and then order a panel of tests and imaging studies. So now we have a stroke workup, a dementia workup, multiple sclerosis workup, and who can ignore the all-encompassing neuropathy workup. After all, something shall reveal itself when the net cast is so wide. And we are slowly retiring the tools of our trade. Who needs a stethoscope to auscultate the heart in a young man presenting with a stroke? After all, that is what a cardiology consult is for! Who needs a stethoscope to auscultate the carotid arteries for a bruit? Just order a carotid Doppler or, even better, a magnetic resonance angiogram of the neck and while at it might as well order a magnetic resonance angiogram of the intracranial vasculature too. The Wartenberg pinwheel is already extinct and the percussion hammer seems to be heading that way too. After all, who cares whether there is a slight asymmetry in the deep tendon reflexes? C. Miller Fisher, arguably one of the best bedside physician scientists, impressed on his trainees to “make the patient’s bedside your laboratory.”2 So while I agree with Dr Berger’s impassionate plea to our colleagues in other medical specialties not to abandon their clinical skills of observation, palpation, percussion, and auscultation, we have to first put our own house in order or else the last beside physician scientists too shall soon go the way of the dinosaurs.