A Short Reflection on Neurology and Epistemology

Sometimes, med is fun. Last year, Neuro taught us history-taking and neuro exam by making us interact with actual patients in the ward under the supervision of a preceptor. We were, then, individually assigned to write a clinical report. I liked it.

Moments like these remind me why I took this path. I like talking to patients, getting their information and putting together the pieces while figuring out which information I still have to ask. Sometimes, I'd have to discern if they're lying. When I learn enough, I'd have to figure out what illness they have, like solving a puzzle. That's basically what it means to take a patient's history, the most important tool for diagnosis.

If I don’t know what the patient has after I have taken the history, I am in serious trouble.

-Alan Yudelt, MD

Writing a clinical report, on the other hand, is organizing the information you already have into a concise but complete presentation that the other doctors should be able to understand. It's just like writing. There's no strict format, and the sample my teacher showed us seemed sloppily written to me that I am challenged to learn to write the most elegantly written clinical reports ever (without spending too much time on them). After all, medicine is an art.

For the clinical report, our witty teacher, Dr. P, asked us to include, at the end, a short reflection on that particular ward work. As it turned out, he read everything and reported a case of plagiarism, where two students apparently had the same reflection. For sometime, I worried that I may have written the same thing as another classmate had. But I guess this is something only I can write?

Neurologic examination is probably the weirdest exam we get to perform on patients, as it involves several functions we take for granted as normal, healthy individuals. Embarrassing as it is to admit, normal findings-- no matter how excellent a news it is regarding the patient’s health-- are pretty boring. Abnormal neurological findings, in contrast, provide an interesting insight into the philosophical debate on proving the existence of an external world, that is, how do we know this is real? How are we sure we aren’t deceived by an evil demon? How are we sure that we aren’t brains in a vat and this reality we believe isn’t just imagined? A philosopher named G.E. Moore, for instance, argues for common sense-- that it is a truism that “the earth had existed also for many years before my body was born.” He argues he can prove the existence of an external world

“By holding up my two hands, and saying, as I make a certain gesture with the right hand, ‘Here is one hand’, and adding, as I make a certain gesture with the left, ‘and here is another'"

However, it would be interesting to let him present his position to a patient without proprioception. I am personally fascinated with the loss of this sense.

And these, my friends, are why I should be here.