Is the Neurological Examination a Dying Art?

November 2, 2010

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By A. Gordon Smith, MD, AAN.com Education Editor

In this era of rapidly advancing technology and increasing limits on the time a physician has to spend with his or her patient, it seems that the physical examination has become less relevant. Indeed, it is often easier to just order the MRI scan than it is to perform a careful examination.

Abraham Verghese, MD, an acclaimed author and internist at Stanford University, is on a mission to rescue the physical examination. Verghese, who was recently profiled in a New York Times article, worries that medical schools have "let the exam slide," resulting in students and residents who are unable to perform an adequate examination.

For example, he observes that many residents don't know how to assess deep tendon reflexes. He argues that a careful physical examination is not only essential for diagnosis, but that it engenders trust between doctor and patient, establishing a potentially profound connection.

Verghese, who is the senior associate chair for the theory and practice of medicine at Stanford, has led the development of the Stanford 25, a list of examination techniques all doctors should know. Neurologists will be pleased to see that at least a quarter involve the neurologic examination.

What is your experience regarding the "health" of the neurologic examination? Is it a dying art? Do we need to re-emphasize bedside teaching in our medical schools and residency programs?

Join the discussion.