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Putting ethics on the spot in neurology

Nature Reviews Neurology volume 5, pages 136–137 (2009)Cite this article

We were queuing for crullers and coffee after a grueling ward round when our eyes were drawn to the choreiform movements of the woman ahead of us. Despite our feeble attempts not to stare, our eyes were drawn to her excruciatingly slow attempts to insert a straw into a glass, extricate cash from her purse, and, balancing her tray precariously, wend her way to a nearby table. Against our better natures, none of us made any real attempt to assist, lest we cause offence or embarrassment. She sat down, adjusted her perfectly positioned spectacles, and began to eat. Later, comfortably ensconced in the doctors' lounge, we began to discuss the phenomenology of her movement disorder, even postulating that adjusting her spectacles was a voluntary maneuver to mask her involuntary choreiform movements.

In medicine, the art of making a spot diagnosis is much lauded; indeed, William Osler, doyen of clinical medicine, declared, “There is no more difficult art to acquire than the art of observation.”1 In 1817, James Parkinson wrote a monograph on his eponymous disease after examining Londoners whose stooped posture and shuffling gait caught his attention.2 Many of his observations hold true to this day, bearing testament to his prescience and clinical acumen. Legend has it that Christian Billroth would start the academic year by sticking his finger into a foul-tasting liquid while informing his students of the two qualities necessary for becoming a doctor: namely, freedom from nausea and the power of observation. He would then enjoinder his students to copy his actions and would smile at their stoic discomfiture, telling them that they had passed the first test but not the second, for he had dipped the index finger and licked the middle finger.

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Authors and Affiliations

  1. ECH Lim is Senior Consultant Neurologist, Associate Professor and Assistant Dean of Education, AML Quek is a Registrar, and RCS Seet is Assistant Professor and Associate Consultant, all at the National University of Singapore and the National University Hospital, Singapore.,

    Erle CH Lim, Amy ML Quek & Raymond CS Seet

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  1. Erle CH Lim
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  2. Amy ML Quek
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  3. Raymond CS Seet
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Correspondence to Erle CH Lim.

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Lim, E., Quek, A. & Seet, R. Putting ethics on the spot in neurology. Nat Rev Neurol 5, 136–137 (2009). https://doi.org/10.1038/ncpneuro1000

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