2014
DOI: 10.1136/jnnp-2013-306881
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Abstract: This review argues that even with the tremendous advances in diagnostic neuroimaging that the clinical skills involved in clinical neurology (ie, history, examination, localisation and differential diagnosis) remain key. Yet a number of recent audits suggest that large numbers of patients are failing to be assessed properly with a risk of patient harm, costly, unnecessary or inappropriate investigations, or delayed diagnosis. We review some of the reasons why patients are not being assessed properly neurologic… Show more

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Cited by 55 publications
(44 citation statements)
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References 33 publications
(53 reference statements)
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“…Teaching methods from specialities such as neurology, geriatrics, and psychiatry will have much to contribute. Physicians underestimate the impact of examination findings when estimating conditional probabilities (Herrle et al, 2011), so Nicholl and Appleton have condensed the history and physical examination skills required for expertise in neurology training (Nicholl and Appleton, 2015). In older adults comprehensive geriatric assessment that considers a variety of problems is associated with better outcomes (Ellis et al, 2011).…”
Section: Looking Forwardmentioning
confidence: 99%
“…Teaching methods from specialities such as neurology, geriatrics, and psychiatry will have much to contribute. Physicians underestimate the impact of examination findings when estimating conditional probabilities (Herrle et al, 2011), so Nicholl and Appleton have condensed the history and physical examination skills required for expertise in neurology training (Nicholl and Appleton, 2015). In older adults comprehensive geriatric assessment that considers a variety of problems is associated with better outcomes (Ellis et al, 2011).…”
Section: Looking Forwardmentioning
confidence: 99%
“…Instead we agree with Yusuf et al 2 that despite advances in non-mydriatic fundus photography, basic skills in ophthalmic assessment are essential and advocate that there is no substitute for appropriate clinical examination. 4,5 It is unrealistic to expect undergraduates to be competent at direct ophthalmoscopy at the end of their short ophthalmology attachment. Instead, these skills should be taught early in the clinical curriculum so that they can be practised, reinforced, honed, and (most importantly) assessed during further attachments in neurology and general medicine.…”
mentioning
confidence: 99%
“…3 Indeed, ophthalmoscopy is considered a fundamental competency of the Foundation Programme. 4 Although it is true that physicians lack confidence in performing direct ophthalmoscopy, the reasons for this are multifactorial. The brevity of undergraduate ophthalmology rotations combined with the lack of practice of ophthalmic examinations by peers (GPs, hospital doctors and so on) may discourage trainees from using an ophthalmoscope when the need arises.…”
mentioning
confidence: 99%
“…However, clinical neurological assessment (assessment of clinical history and neurological examination) continues to be an essential activity and of the utmost importance 1 . The excessive importance attached to complementary examination as a means of compensating for inadequate assessment of a patient's clinical history and an incomplete neurological examination has led to various problems in clinical neurological practice 1 . It is against this background that some findings have been highlighted in the neurological literature.…”
mentioning
confidence: 99%