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Noticing in neurology
  1. A J Lees
  1. Reta Lila Weston Institute of Neurological Studies, University College London, London WC1H 9JR, UK
  1. Correspondence to Professor A J Lees, Reta Lila Weston Institute of Neurological Studies, University College London, London WC1H 9JR, UK; andrew.lees{at}


There are three classes of people: those who see, those who see when they are shown, those who do not see Leonardo da Vinci

The three cardinal qualities necessary for the ideal neurologist are observation, the ability to reason backwards inferentially and specialist knowledge. Modern medical technology has greatly increased the ability to diagnose and treat disease but it has also encouraged a benign variant of abulia, which is killing off the art and science of clinical reasoning. Intent gazing at the unfamiliar with old eyes or a long look at the familiar with new eyes offers the neurologist an opportunity to discover hitherto unnoticed diagnostic signs far beyond the resolution of the brain scanner and even the light microscope. While there may be nothing new under the sun, there are plenty of old things that no one has observed, which have the potential to greatly improve clinical practice.

  • noticing
  • inspection in neurology
  • sherlock holmes
  • charcot
  • observation in neurology

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by Kevin Talbot, Oxford, UK.

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