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Comment & Response
March 2018

Future of Neurologic Examination in Clinical Practice

Author Affiliations
  • 1Department of Neurology, Haukeland University Hospital, Bergen, Norway
  • 2Department of Clinical Medicine, University of Bergen, Bergen, Norway
JAMA Neurol. 2018;75(3):382. doi:10.1001/jamaneurol.2017.4995

To the Editor I read with interest the article1 by Aminoff. The importance of the message is clear: neurologists need to remember how to elicit clinical signs. That these signs are of equal, and possibly of greater, value to the readouts or images generated by “supplementary” tests is due to the patient’s perceptions of us as physicians. Our increasing ability to image, analyze, and assess human biology is impressive, but runs the risk of rendering us purely technical and thus eminently replaceable. As and when computer technology attains the speed and complexity to drive algorithms that can accurately diagnose complex diseases, and this is no longer a remote possibility, those who input the data will require only rudimentary knowledge of the relevant diseases. Therefore, I would argue that we must not only retain the ability to examine the patient, but also to take a proper clinical history. Indeed, I would go even further and suggest that the latter is the more important. Neurologists are among the few clinical specialists who still take a detailed history, and we do so because it is this that guides both our clinical examination and the subsequent battery of tests with which we localize lesions within the nervous system. The ability to extract the clinical information and assess symptoms provides us with vital information concerning the nature of the disease, where we should look to find it, and what it means to the patient.

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