eLetters

125 e-Letters

  • Saving the grand round
    Nitin K. Sethi

    I read with interest the article by Dr. Stern and the accompanying comments by Dr. Warlow in which they lament about the deteriorating standards of grand rounds in the academic neurology institutions of today. Here across the Atlantic we too are confronting some of the same issues. The standard of grand rounds varies from institution to institution. In certain institutions the job of organizing the grand rounds is wholly en...

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  • The grand round has a broad spectrum of educational benefit
    oscar,m jolobe

    Given the fact that the advent of medical admissions units(MAUs) and their ethos of "physician of the week" has coincided with increasing subspecialisation(1), physicians with a special interest who participate in the MAU on call rota are now the ones in greatest need of the educational benefit conferred by grand rounds. In this context the grand round has the potential to refresh those "generalist" diagnostic skills which...

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  • Re:Why I shall never stop examining patients
    Jan M. Keppel Hesselink

    Dear Editor,

    With great interest I savoured the editorial by Dr. Warlow (1). Apart from learning the meaning of the word shibboleth, his analysis is most crisp and brings us back to the most important factor in medicine: the interaction between patient and physician.As a pain specialist I see many patients suffering from neuropathic pain, and I always examine thesm, especially their painful feet.Although I can...

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  • Good doctor, bad doctor: who images more?
    Nitin K. Sethi

    Dr. Al-Shahi Salman in his editorial writes about the dangers of acting on incidental findings on brain MRI. He says primary prevention by avoiding MRI in the first place is the best approach. Unfortunately today in the United States avoiding imaging is easier said than done. The pressure to do a quick MRI is omnipresent. Thus almost every patient who walks into the emergency room with a headache, a new onset seizure or even...

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  • the practical approach also requires recognition of cardiogenic vertigo
    oscar,m jolobe

    Over and above the recommendation that clinicians should have a low threshold for lying and standing blood pressure measurements in the elderly, even when the history is not typical(1), mention must also be made of the role of cardiac investigations such as telemetry, so as to identify conduction defects as an underlying cause in patients who present with vertigo(2), even though this issue was not raised by the authors. Th...

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  • Why I want to be a Neurologist?
    Lekhjung Thapa

    Dear Sir,

    The article "Why I became a neurologist" passed through my brain into my heart because I am in the same place as you were so many years ago. The world has changed a lot, but in different countries at different paces - we in Nepal are many years behind you in Australia. You were inspired by your father and grandfather by virtue of their intelligence, but for me I became interested in neurology, and in stroke...

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  • a restatement of core values
    oscar,m jolobe

    Professor Warlow is to be congratulated on his masterly restatement of the core values of clinical medicine, in general, and neurology, in particular(1). As a corollary to his observation regarding "whether what you find on imaging is relevant to the problem or is merely incidental"(1), recognition should be made that the scan, itself, may generate images which are either falsely normal(2), or too nonspecifically abnormal...

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  • Why I shall never stop examining patients
    Nitin K. Sethi

    Dear Editor,

    I read with interest the editorial by Dr. Warlow (1). It follows the earlier editorial by Dr. Hawkes titled "I have stopped examining patients" (2). That editorial evoked a fury of concerned responses from both neurologists and neurologists to be. The editorial by Dr.Warlow will be far less controversial and I feel aptly balances the debate between examining and not examining neurologists. Dr....

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  • neurogenic bladder dysfunction and chronic subdural haematoma
    oscar,m jolobe

    Although no mention of subdural haematoma was made by the authors(1), the occurence of reversible urinary retention, even in a patient who is awake and ambulatory, can be a feature of bilateral chronic subdural haematoma, as was the case in an 87 year old woman reported by Lang et al(2). On the basis of the fact that she regained full bladder control after evacuation of the haematoma, the authors proposed that there might be...

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  • another moral from the cautionary tale
    oscar,m jolobe

    The cautionary tale of miscalculation of the corrected QT interval(1) highlights the extent to which clinicians and their patients can become hostages to fortune when they base important clinical decisions on "numbers" churned out by electronic gadgets whose validity has not been "cross checked" manually. The sometimes indiscriminate use of oscillometric devices for blood pressure measurement is another case in point. My anx...

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