What Old Fashioned Neurology Offers 21st Century Medicine

Like other areas of medicine, Neurology has experienced phenomenal technological achievements during the last thirty-five years.  Our current stellar imaging and modern therapeutic modalities couldn’t have been imagined at the time of my training in the 1970s.  Back then we focused on EEG, pneumoencephalography (I shudder even recalling that archaic and painful test), skull X-rays, the “black box” of Dr. A.B. Baker, and the importance that psychological influences had for neurological symptoms.

With improved recall of information via computer searches, current knowledge is more accessible than before.  The practice of medicine has become more sophisticated, and we must never denigrate such great progress. However these wonderful technical successes also place our profession at risk of becoming overly insular.  A tendency exists for current physicians to interact less with colleagues and to spend more time with machines.

During my internship and residency on-call nights, the midnight meal  provided social lubrication that benefited the collective care of patients by physicians of different specialties.  Over the day’s leftovers, the house staff met to discuss cases, tell stories, gossip, and let down their professional guards. We would lay down our stethoscopes and put up our feet.

I don’t know if this quaint custom even still exists.  If it does not, then other means are needed to provide a human interface among physicians, so that our most personal and caring of professions never veers into a numbers crunching, overly compartmentalized group of disciplines.

The evolution of modern medicine will rely heavily on doctors, hospital administrators, and other staff working together to solve common problems. An active exchange of thoughts among all members of the health care team will be required to bring about a truly integrated health care system that reduces costs, cuts medical errors, and advances quality and safety. The neurological approach, despite appearing anachronistic, offers an example that might provide advantage.

Neurology with its reliance on medical history and careful neurological examination remains an anachronism in modern medicine.  Who else but neurologists still tote around little black bags?  Who else but a neurologist spends more time taking medical histories and performing examinations than reviewing laboratory tests?  Neurologists must not avoid the newer technological achievements.   But perhaps by the anachronistic nature of our discipline, Neurology has become a model for a bridge from the present to the more humanistic, interconnected physicians of the past. Such improved socialization of medicine represents my fondest wish for medicine.  Moreover I hope our discipline that parenthetically McDonald Critchley endearingly referred to as “The Divine Banquet of the Brain” and by which I was seduced so many years ago, leads the way toward an improved interconnected clinical effort from which patients will benefit.

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