examination

Do you shake hands with your patients? I think you should, usually. As a junior doctor I was impressed by the example of consultants who greeted their patients by shaking hands and adopted this as a life-long practice. I would not claim that shaking hands is diagnostically useful: the detection of extrapyramidal rigidity or myotonia is more likely to be made from special tests of tone than from the initial handshake.

The neurological examination has grown with our profession over the past 150 years. Neither the examination as a whole nor its individual parts have been subjected to the sort of rigorous evaluation which would command an instant Level A recommendation from an EFNS guideline panel. Nevertheless as a Good Practice Point the examination commands the leading position in the list of neurological investigations. Last year Johnston and Hauser, editors of the Annals of Neurology (volume 70, A10), called for research into the value of the different aspects of the “ethereal” neurological examination. The call was hotly debated in subsequent correspondence as being either overdue on the one hand or unnecessary and inappropriate on the other.