When I was a medical student in Edinburgh, back in the 1960s, we were all taught on fear of death to undress patients down to their underwear and examine them from head to toe. Scare stories abounded with statements like “if you don’t put your finger in it, you’ll put your foot in it” or “he would have got the diagnosis if he had bothered to examine the abdomen”. Patients were accustomed to this type of thoroughness. But over the years we have modified our approach—many patients now object to undressing routinely in the clinic unless you can give them a really good reason, and they may respond that “my general practitioner (GP) has already done that”.

It is true that for a neurologist, the yield from general medical examination is fairly small, in proportion to the time taken. Why use a stethoscope when carotid duplex or an echocardiogram will give infinitely superior information? When did you last diagnose mitral stenosis with a stethoscope? I guess not for many years. And what about an atrial myxoma? I have diagnosed this twice (by chance) but only after an echocardiogram. A carotid bruit is nice to pick up but it is sometimes due to turbulence without serious stenosis, or it is on the “wrong” side, and it cannot measure reliably the degree …