Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When new technology is no match for old-school medical tests

Patrick Connolly, MD
Physician
May 21, 2021
97 Shares
Share
Tweet
Share

In his 1862 novel, Fathers and Sons, Ivan Turgenev describes (spoiler alert) a death from sepsis in excruciating detail. There is nothing to do but comfort the man in the throes of mortality, his parents, and unrequited love at his bedside.

Today, thankfully, modern technology and processes can deliver a quick diagnosis and treatment, often saving the patient’s life and about two weeks of brutal suffering. Technology is essential, but attention to detail and clear communication save as many lives as flashy new innovations.

The neurological exam remains an essential — and low-tech — part of our patient picture. There is no automation or waveform for the neurological exam. It requires observing, interacting, touching the patient, one human to another. First, we determine a level of consciousness, then we evaluate strength and sensation, walking, coordination, and cognition. It can be thorough and exhaustive, but at the bedside in the hospital it’s often a quick check, something we can track repeatedly over time, observing for changes.

The exam we know has been pretty much the same since the late 19th century, organized in a particular way and filled with shorthand eponyms: Babinski, Hoffman, Bell, Jackson, Broca, and Wernicke – dead European men.

There is a “normal,” a ground truth, but that is quite subjective and fuzzy around the edges. Some days the exam feels cursory, routine, even crude, and on others, it’s pivotal.

Sunday night, my patient was fine, but by Monday morning she slipped into a coma. The thing I was worried about is happening. A CT only confirms it, revealing no surprises. I cancel my office appointments for emergency surgery. Another patient is much better today. Maybe she can go home with her family instead of to rehab. The neuro exam shapes our work and patients’ lives. It’s important.

We know more about the brain than ever before. It’s been mapped, measured, modeled in innumerable ways, from molecule to society. But before MRI, before CT, before even X-ray, there was the neurological exam. Its simplicity, its crudeness, both assures and challenges us, and modern technology has not supplanted its utility. A CT or an MRI is a snapshot in time. The patient’s consciousness is an interior flow of unrecordable experience. The neurological exam bridges the two, giving us something that’s at once subjective and objective, reproducible and fuzzy, technical and human, ephemeral, but we can make notes about it.

It bothers me that the neuro exam feels so rudimentary and momentary, as if I’m some cleric in a Russian novel, with a white cassock and enigmatic oils. I trained for this. There is science and method and history and I know I’ve helped people. Still, I go to work with beliefs and perceptions, and guesses. There is uncertainty because it’s us, who we are, how we are.

But there’s a rich plasticity in the shadow of uncertainty. That’s who we are, too. The leg is stronger in the recovery room. She’ll walk better. The tremor is suppressed. He’ll be able to use a spoon. Neurological findings that are notes in a chart for me can be significant inflection points in people’s lives. An articulate 80-year-old man has worsening speech for two weeks. He has a malignant brain tumor in a bad spot. Treatment might prolong his life for a year in exchange for a persistent deficit, so maybe he just wants to go home. Inflection.

Having a full life in 1862 seems like a lucky occurrence, but there was an acceptance of how things would turn out then, before scans and science and systems soothed us into a false sense of certainty.

The first time I thought I might like to be a neuro-something was in 1992 when Ben Carson came to give a talk at Johns Hopkins Applied Physics Lab. He described the pathway from the ear to the auditory cortex. Compressive waves of air gain significance as words, music and memories, emotions and sensations that define and inspire or demur or despair.

It’s so strange and magnificent that we’re all wired pretty much the same way, yet we’re each our own baseline, unique in our own skin. The neuro exam reveals that — generalizable, scientific, unique, human. It’s a little bit 19th century, and that’s OK.

Patrick Connolly is a neurosurgeon. This article originally appeared in the Philadelphia Inquirer.

Image credit: Shutterstock.com

Prev

Forensic pathology's dirty secret

May 21, 2021 Kevin 1
…
Next

A physician hung himself. That could have been me. [PODCAST]

May 21, 2021 Kevin 0
…

Tagged as: Surgery

Post navigation

< Previous Post
Forensic pathology's dirty secret
Next Post >
A physician hung himself. That could have been me. [PODCAST]

More by Patrick Connolly, MD

  • Why the internet can’t replace your doctor

    Patrick Connolly, MD
  • My patient and I were born on the same day. It took a tragedy to bring us back together.

    Patrick Connolly, MD
  • How washing hair taught me to be a better doctor

    Patrick Connolly, MD

Related Posts

  • End medical school grades

    Adam Lieber
  • Match Day: the perfect ending to the medical school experience

    Valerie A. Jones, MD
  • Use technology to fix medical education

    Jimmy J. Qian
  • The medical school personal statement struggle

    Sheindel Ifrah
  • Why medical school is like playing defense

    Jamie Katuna
  • The unintended consequences of free medical school

    Anonymous

More in Physician

  • A tense family drama unfolds as a young daughter pursues unconventional career path

    Osmund Agbo, MD
  • Decoding the brain’s decision-making: insights for medical professions and strategies for success

    Harvey Castro, MD, MBA
  • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

    Jay K. Joshi, MD
  • Discover your true north: Navigating life’s confusions and embracing your path to success

    Tyler Jorgensen, MD
  • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

    Anonymous
  • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

    Veronica Bonales, MD
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Insomnia Symptoms Tied to Stroke a Decade Later
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • Full-On Reversal of Cardiac Amyloidosis Possible With Antibodies
  • Spell Check-Up: Do You Have the Skills to Pass This Spelling Test?
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds

Meeting Coverage

  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...