How Neurologists Make Diagnoses

Nice article from Dhand et al in the journal Neurology. The authors identified six neurologists with > 10 years of experience and both interviewed and observed them in practice.

Using these experiences, they then classified the extent to which a number of major diagnoses rely on three modalities of information: clinical (history & physical), laboratory and electrodiagnostics (e.g., EMG), and neuroimaging.

Along with other results, they then present a “diagnosis cube” that visualizes how diagnosis types vary along these dimensions. Note that all diagnosis types receive a rating of “4” in the clinical category, so the variance is in the other dimensions.

Diagnosis cube; doi: 10.1212/WNL.0b013e3182a840c7

Diagnosis cube; doi: 10.1212/WNL.0b013e3182a840c7

It will be interesting to see whether certain diagnoses, especially psychiatric, increase in their reliance upon non-clinical information modalities as our understanding of their pathophys improves. Also of note is that Alzheimers is included as a subset of dementia, which is C4L1N2.


Dhand et al. 2013 How experienced community neurologists make diagnoses during clinical encounters. Neurology, doi: 10.1212/WNL.0b013e3182a840c7. (Image included via educational fair use.)