How neurologists think?

It’s not enough for the medical student to learn concepts. It’s important to reflect on the competencies that you must develop to face your future professional reality.

But, after all the clinical training and all the stress on him always find himself, will he change his way of thinking, acting?

In this brief guide we are going to answer the question ‘’How neurologists think?’’ We will discuss how clinical training affects the way neurologists think and act, as well as detail the reasoning they use to solve problems.

How neurologists think?

The reasoning of a physician when integrating the medical history, physical examination, and laboratory studies to arrive at a diagnosis and define a treatment is a complex process.

This analysis is part of the competencies that students must develop during their training. However, education specialists point out that it’s important for students to go beyond theoretical knowledge.

It’s not enough that they learn concepts. It’s essential that they develop various skills so that they can face their future professional reality. Especially in an uncertain, complex environment with unlimited possibilities.

Now, clinical reasoning is a process that aims to solve a specific problem: diagnosis, and it’s the clinical doctor who performs this cognitive process based on certain premises based on the scientific method, which consists of postulating one or more hypotheses that must be put to the test, that is, contrasted with what we perceive through the senses and that in a very general way we can call “reality”.

Critical thinking

Due to the type of activity that doctors carry out, it’s common for them to develop critical thinking, which consists of the ability to interpret, analyze, evaluate, make inferences, explain and clarify meanings.

This has important repercussions on professional decision-making processes, such as the diagnosis and treatment of patients; and personal, such as continuing medical education. Critical thinking involves the components: explanation, inference, interpretation, and analysis.

The explanation consists of the presentation of arguments and the justification of the process, it requires a decision and intellectual courage to sustain the arguments.

The inference has to do with the search for evidence and the determination of conclusions, in which the student needs flexibility and openness to consider all points of view honestly and fairly, even if they diverge from her position.

Interpretation integrates categorization, determination of meanings, and clarification of ideas. This speaks of self-regulation of your own learning. On the other hand, the analysis also requires the identification of arguments and their analysis.

For the development of critical thinking, curiosity and mental acuity must be encouraged; a dedicated reason and hunger to acquire reliable information.

Creative thinking is the ability to create new and different points of view of the same subject, involving the decomposition and restructuring of knowledge to understand it in greater depth.

This competence is defined as the creation of different and innovative solutions, which are sustainable for the community and the environment, and which come from an analysis that ensures their viability.

Principles of Health Care

The American College of Physicians, together with the European Federation of Internal Medicine and the American Board of Internal Medicine, have indicated the three fundamental principles of medical practice, these are:

Well-being of the patient

Premium over other securities. It forces us to serve exclusively the interest of the patient. For this reason, the altruism and generosity characteristic of the doctor contribute decisively to the patient recognizing this value in the professional.

Consequently, it’s not a value that should be influenced by social, administrative or other currents or pressures (including, of course, economic ones).

Autonomy of the patient

Another fundamental principle is that the doctor must respect the decisions of his patients, provided that these don’t attack medical ethics or lead to an inappropriate practice. And this is a principle that also contains another value: the honesty of the doctor with the patient so that he is aware of reality and can make decisions that later have to be respected.

Social justice

The doctor is in charge of promoting justice within the health system and also denouncing injustices or possible discrimination in the provision of health services based on unjustifiable reasons (sex, race, socioeconomic status, religion or any other).

The doctor has to promote that all those who are in the same health conditions have access to the same alternatives. The opposite is neither fair nor equitable. And this has special consideration when it comes to a fair distribution of resources.

Since resources are limited, discrimination in its application is unethical, nor is it unethical to consume resources without justification.

How do neurologists think with a patient?

The clinical method is nothing more than the scientific method applied to working with patients.

The stages of the clinical method will be the same as indicated above with specific peculiarities for clinical work.

1. The problem, in this case, is the disorder or loss of health, for which the patient consults, which motivates the patient to request the help of the clinician. This problem or problems because it’s not infrequently a single one- must be specified with all clarity.

If it’s part of falsehood, an assumption, a product of superficiality or haste in the first contact with the patient, it will be absurd to think that the clinical method can be applied successfully.

2. The search for basic information in the clinical method refers specifically to the questioning and physical examination of the patient, that is, to the medical history. This procedure is generally directed or guided by previous experience and by the knowledge that the clinician possesses regarding the explanatory hypotheses of the problem.

However, the clinician must be open and somewhat eclectic in this search for information, because a very closed position can inhibit the flow of information from the patient or family.

3. The hypothesis or conjecture in the clinical method is the presumptive diagnosis (s). It’s essential that this diagnosis or diagnoses are well defined, based on the information collected and have a foundation.

It’s logical that if the search for information was deficient or inaccurate, the hypotheses will not have any possibility of being verified and all the following steps will not have any basis.

4. We test the presumptive diagnosis by studying the evolution of the patient and scheduling various laboratory, imaging, pathological and other tests, that is, of modern technology at our disposal.

Don’t forget that these techniques are not inhuman, they are also performed and interpreted by humans. 

Just as clinicians analyze, interpret the symptoms and semiology offered by the patient, radiologists and pathologists analyze and interpret images and tissues. Both the analysis of the clinician and the analysis of radiologists, pathologists or microbiologists.

6 characteristics that every good doctor should have

It’s well known that deciding to choose the medical profession is one of the decisions that most implies having an extremely special vocation for studies and service.

The fact that in all professions, people must have a number of qualities to carry out a good practice of their exercise is not something new. But it’s even more so in Medicine, where the professional has to have human and behavioral qualities.

If you have sometimes wondered how to be a good doctor, here are some tips to become the favorite of your patients:

• Your first concern should be the health and well-being of your patients.
• You should treat all your patients equally, without distinction of their origin, social class, religion, beliefs, lifestyle. Always remember that your goal is to treat them, not judge them.
• Inspire confidence. Confidentiality is the foundation of the doctor-patient relationship. What is said in the doctor’s office does not have to come from there.
• As much as you have esteem for a patient, remember to never get emotionally involved. Although you should be empathetic, you should not let your emotions affect your work.
• Don’t be afraid to say “I don’t know.” It’s better to admit ignorance to something than to make a decision that could harm your patient.
• Always stay well informed and always worry about updating yourself whenever new knowledge appears in your area.

A few years ago a study carried out by the Mayo Clinic on 192 patients focused on knowing what to look for in a doctor, revealed that the most valued by patients is that they have empathy, be human, have a personal treatment, be direct and respectful.

Below we will briefly explain how you can improve your treatment in these areas:

Trust

Don’t be bothered by questions from patients about medical information acquired from other sources regardless of its veracity. Be accessible to the patient, family and colleagues and save all the information they give you. Remember that they are fully trusting you with their person.

Empathy 

Make eye contact with the patient and family members. Correctly interpret verbal and non-verbal communications, reiterate your patient’s concerns, and speak in a pleasant and calm tone of voice. Remember that many people just go for consultation makes them nervous.

Humanity

Use appropriate physical contact. Be attentive and show interest in spending adequate time with the patient through unhurried movements. Ask the patient personal questions about their life, but without making it uncomfortable. 

Use the appropriate humor and remember details of the patient’s life known in the previous visit, you can help yourself from a notebook or electronic records.

Openness 

Don’t disguise or hide information. Don’t use medical terms assuming they are logical. Remember that you studied 6 years of medicine and he did not. Explain the pros and cons of the treatment. Ask the patient to recap the conversation to make sure they have understood.

Respect

Listen carefully and don’t interrupt when the patient describes their symptoms. Respect the modesty of the patient during the medical inspection.

Method

Provide detailed explanations and written instructions. Appoint the patient for adequate periods.

However, beyond being doctors, neurologists are also human, although they must think critically all the time, mistakes can occur, or they can get emotionally involved. However, their clinical practice has placed them in a place where professional ethics are stronger than their person.

FAQS: How neurologists think?

References

Vickrey, B. G., Samuels, M. A., & Ropper, A. H. (2009). How neurologists think: A cognitive psychology perspective on missed diagnoses. Annals of Neurology, 67(4), 425–433. https://doi.org/10.1002/ana.21907

Diaz Guzmán J. (2020). [Clinical reasoning in neurology]. Neurologia (Barcelona, Spain), 19 Suppl 1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15372335/

‌Neurologist job profile | Prospects.ac.uk. (2019). Retrieved October 31, 2020, from Prospects.ac.uk website: https://www.prospects.ac.uk/job-profiles/neurologist

‌