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Clinical neurology: a changing role?
  1. Michael Swash
  1. Correspondence to Professor Michael Swash, Department of Neurology, The Royal London Hospital, The Royal London Hospital, London EC2Y 8BL, UK; mswash{at}btinternet.com

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Nicholl and Appleton1 suggest that the classical technique of history and examination, a skill assiduously acquired by generations of physicians, perhaps especially by neurologists, has begun to fall into disuse, even neglect. This is not a new issue, but has it become more evident as the scope, sensitivity and accuracy of diagnostic investigations, especially neuroimaging, has increased? Neurologists do not follow the ‘full examination’ protocol described in undergraduate textbooks2 but use heuristic processes to shortcut the process.3 Thus, the old adage ‘if you don't know the diagnosis a few minutes after you meet the patient you probably never will’. …

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