The development of precision medicine, gene therapies,
advanced imaging techniques, novel monitoring systems, ingestible or
injectable sensors, and remote medical care (telemedicine) is leading to
remarkable changes in health care. But the increasing ability to
deliver care remotely will also reduce physical interactions between
physicians and patients, with implications that have barely been
explored.
There is no doubt that the art of the neurologic
examination is already being lost, as some of these advances come to
supplant rather than complement the clinical examination. Indeed, the
modern trainee neurologist can perhaps be pardoned for wondering about
the place of the clinical examination when, for example, magnetic
resonance imaging or computed tomography can detect, localize, and
provide prognostic information about a central lesion in just a few
minutes and genetic studies can diagnose certain disorders regardless of
the clinical findings. The neurologic examination requires time,
patience, effort, and expertise and may have to be performed in
difficult or unpleasant circumstances, whereas an imaging or laboratory
study simply requires completion of a request form and the
responsibility is passed to a colleague. Why, then, examine the patient?
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