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End the cult of cotton wool
  1. Geraint Fuller
  1. Correspondence to Dr Geraint Fuller, Department of Neurology, Gloucester Royal Hospital, Gloucester, GL1 3NN, UK; geraint.fuller{at}glos.nhs.uk

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Towards the end of a neurological examination, the tyro, usually a medical student about to take finals or a junior doctor taking higher examinations, gets out a piece of cotton wool and starts dabbing. ‘Tell me when you feel this’, they say before they start touching one side then the other in an apparently systematic way. They touch each dermatome, from top to bottom. The patient patiently responds ‘yes’, sometimes attempting to help with ‘I felt that more’, as this continues. This process goes on for some time.

As a rule, not much useful clinical information is gleaned from this—beyond establishing that some areas are more sensitive than others (most will have discovered this in childhood). The examination has taken time, patience and an effort of concentration from the patient, to little avail.

The medical student (or junior doctor) is doing a dance, taught to them by well-meaning doctors who …

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