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Metaphors convey meaning. Two well-worn (perhaps tired?) examples are the ‘canary in the mine’ and the ‘elephant in the room’. David Nicholl and Stuart Wetherby bring these two old friends together (see page 204), along with the important data from recent national audits, to highlight the limited neurological assessment received by patients presenting to UK acute medical services. The historical emphasis on the clinical method has now been replaced by an over-reliance on technology—providing different and complementary information. How we go about addressing this deficit in clinical examination is a challenge. The first step is to recognise the problem exists at the coalface of acute medicine (yes, they use that too).
The practical value of bedside clinical assessment is well illustrated by Diego Kaski (see page 210) as he reviews the assessment of patients with vestibular disorders and the positional manoeuvres to diagnose and treat positional vertigo. Most neurologists will be familiar with the satisfaction in successfully treating posterior canal benign positional and positioning vertigo—and their patient's gratitude. Being able to treat the …