I saw a patient with early Parkinson’s disease a few weeks ago whose first symptom was an inability to spread butter evenly over his morning toast. i am still collecting and fascinated by new clinical presentations after all these years
Andrew Lees
11.5K posts
Andrew Lees
@ajlees
Professor of Neurology at UC London
Author of Ray Kennedy biography, The Hurricane Port, Mentored by a Madman, Brazil that Never Was and Brainspotting.
- To be a neurologist you need to be a good doctor, an enthusiastic teacher and a clinical researcher All 3 are possible but nowadays harder to achieve It is not enough to pleasantly follow guidelines and clock off. There are also occasions when you may need to break convention
- I need 60 minutes and an informative GP's letter to see a new patient. It takes me 15 mins. to take a history, 5-15 to do the focused examination,15 to give the diagnosis and arrive at an agreement on the best treatment and 15 to chat about the patient's life and interests.
- Low dose amitryptiline (10-20mg) is another oldie but goody on the Parkinson's disease smorgasbord. It is much better than SSRIs for depression, it can help nocturia and also is excellent for associated disturbances of gastro-intestinal motility. For now its also very affordable
- Neurology is different from other internal medical specialities in that the examination is still often indispensable . Instead of salivating over new tests neurologists should enthuse over the beauty of high touch medicine and challenge payers to reimburse it appropriately
- My advice to young neurologists: Neither a leader nor a follower be Be a light unto yourself, always, check your sources, question everything Remember our literature began with Thomas Willis not with Aaron Aaronson PLOS 2024
- There are now many wonderful researcher-neurologists. but very few neurologist-researchers. The 'little individuals ' who build their research around their practice are crying out for help. If something is not done they will vanish with the ghosts of Holmes and Critchley. @UCLIoN
- To be a neurologist you need to watch narrowly and listen openly
- A clinical mistake leading to a missed diagnosis, an unusual presentation of a common disorder, a new clinical sign that may aid diagnosis and save money should all be written up. Case reports are back even if the editorial popes and H index narcissists don't like it
- When I was a junior doctor we rated our teachers not by their impact factors or research prowess but by their teaching skills and clinical acumen. You cant leave medical training to educationalists and scientists who have never cared for patients
- A neurologist should have wide-ranging curiosity, inventiveness and an eagerness to find something new. To be an innovator one must risk making a fool of oneself and be prepared to admit error in public.
- Neurology is subjective. In addition to observation and listening, intuition compassion, urbanity and common sense are valuable attributes for a practioner. Leave machines to do the washing up, never trust them for matters of life and death
- I have found amitryptiline followed by propranolol to be the most effective drugs for migraine prophylaxis when lifestyle changes have failed. Patient preference is of course important but it seems to be another clinical neuropharmacological area where old and cheap is better?
- This week I saw a patient with Parkinson's disease whose partner told me that when he talks in his sleep his speech returns to how it was before the illness began ten years ago. The dreaming voice was both loud and crystal clear I have never heard this story before @basbloem