Noticing in neurology

Pract Neurol. 2019 Oct;19(5):427-430. doi: 10.1136/practneurol-2018-002176. Epub 2019 Apr 4.


There are three classes of people: those who see, those who see when they are shown, those who do not see Leonardo da Vinci The three cardinal qualities necessary for the ideal neurologist are observation, the ability to reason backwards inferentially and specialist knowledge. Modern medical technology has greatly increased the ability to diagnose and treat disease but it has also encouraged a benign variant of abulia, which is killing off the art and science of clinical reasoning. Intent gazing at the unfamiliar with old eyes or a long look at the familiar with new eyes offers the neurologist an opportunity to discover hitherto unnoticed diagnostic signs far beyond the resolution of the brain scanner and even the light microscope. While there may be nothing new under the sun, there are plenty of old things that no one has observed, which have the potential to greatly improve clinical practice.

Keywords: charcot; inspection in neurology; noticing; observation in neurology; sherlock holmes.

Publication types

  • Historical Article

MeSH terms

  • History, 19th Century
  • Humans
  • Neurologists* / history
  • Neurology* / history
  • Patients
  • Practice Patterns, Physicians' / history