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I’ve stopped examining patients!
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  • Published on:
    A plea to neurologists, especially privileged British neurologists.

    Sometimes it is necessary to make a point with overemphasis and we believe that was done in the letter by Chris Hawkes. We agree that it is essential to talk to a patient and to watch them and observe how they speak, what they are saying and what they are doing with their body as they walk in and out of a room. However, to exclude the examination is a form of conceit. The only reason that a very senior neurologist can o...

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    Conflict of Interest:
    None declared.
  • Published on:
    Stop examining patients? Stop investigating them also.

    I am in general agreement with the notion expressed in Professor Hawkes' editorial that many patients in neurology outpatient clinics do not need examination. Certainly, the full neurological examination has a rather Zen-like quality: it takes a great deal of work to master it and then one finds one doesn't really need it. However, I would like to express a number of disagreements with some of what Professor Hawkes wr...

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    Conflict of Interest:
    None declared.
  • Published on:
    The death of the neuro exam: not so soon please!

    Dear Editor,

    I read the title of Dr. Hawkes’ editorial three times before I was certain I had read it correctly1. As a fourth year medical student about to apply for a neurology residency, I was initially bewildered. When I read on though, I was impressed not only with his candidness, but also by the validity of what he was saying; although I am a newcomer, it does not take long to appreciate that imaging is cent...

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    Conflict of Interest:
    None declared.
  • Published on:
    The death of clinical neurology: not so soon please!

    Dear Editor,

    I read with interest the editorial by Dr. Hawkes titled “I have stopped examining patients!”1. The title appropriately has an exclamation mark at the end highlighting his shocking claim. I have to commend Dr. Hawkes for finally coming out and admitting boldly and maybe somewhat proudly what most neurologists already know but are afraid to accept.
    Bedside clinical neurology is a dyin...

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    Conflict of Interest:
    None declared.
  • Published on:
    Careful Examination Irreplaceable

    Dear Editor,

    Perhaps because I don't have Dr. Hawkes' degree of experience (I have approximately 25 years of practice experience), I disagree very strongly with his conclusion. Careful examination remains the cornerstone of neurologic practice. I agree that a great deal of information is gleaned from informal examination - watching the patient walk into the exam room, etc. I agree as well that for paroxysmal d...

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    Conflict of Interest:
    None declared.
  • Published on:
    Premature closure and other unintended consequences of omitting the clinical examination

    Dear Editor,

    The admission that a neurologist has stopped examining patients(1) is a disturbing one, given the fact that "the practice of medicine is the art of drawing conclusions from incomplete evidence"(2), thanks to the fact that, as clinicians, "we work in a probabilisic enviroment in which the evidence we gather bears an imperfect relationship to its cause"(3).

    Accordingly, the evidence initial...

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    Conflict of Interest:
    None declared.

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