Who needs an MRI? Welcome to the Third World

This post was inspired by a comment made by one of my professors during a lecture last week. She was explaining to the class how older, experienced physicians (from ‘way back when’) can pinpoint lesions with great accuracy based on symptoms and signs alone, without the need for fancy modern equipment such as MRI scanners. This is of course true, but it got me thinking of my own medical education.

One of the advantages of having studied medicine in a Third World country is that I was taught from early on to rely on clinical features to come up with accurate and precise diagnoses. While I am certainly no expert in doing so, I think people who practice in underdeveloped countries have a distinct advantage over their more technologically-oriented counterparts in developed countries. This is particularly true for emergency situations – MRI machines (and even CT scanners) are few in poor countries – laboratory tests are often outdated and transiently available and immunologic or genetic testing are especially cumbersome to locate. Thus, a junior doctor quickly develops the prowess of analyzing a patient’s presentation to come up with a single faulty aspect to be blamed.

In no other discipline is pinpointing precise lesion locations more important than in neurology. In fact, that is what neurology is all about. If we were to remove this aspect of the discipline then the specialty as we know it would cease to exist. In the preface to the first edition of one of my favorite books: ‘Introduction to Clinical Neurology’, neurologist Dr. Douglas J Gelb asks that very question – Is neurology obsolete? At least it lives on in developing countries, for now.

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