The concept of neurophobia and how this book wants to help you.
It is an understatement that most veterinary practitioners do not enjoy assessing neurology patients. Neurology is often considered a difficult and complex medical specialty, which cannot be practiced successfully in a first opinion practice setting. It is commonly assumed that neurological conditions can only be diagnosed by expensive diagnostic imaging modalities and that most animals affected by neurological disease have a poor prognosis. This fear or unease for clinical neurology and neurological sciences is called ‘Neurophobia’, which is a recognized academic concept in human and veterinary medicine. In recent years, multiple studies have evaluated the causes, consequences, and solutions for neurophobia. Neurophobia has important clinical consequences and is associated with a lack of confidence to rationally assess neurology patients and perform a neurological examination. Neurology patients are therefore often referred to specialist centres for the sole reason that they have a neurological condition. Occasionally, inappropriate treatment or even euthanasia is considered for clients that decline referral.
Animals affected by neurological disease can indeed present with dramatic clinical signs, which can be upsetting for the owner and overwhelming for the veterinary practitioner. Many acute neurological conditions can however be treated successfully in clinical practice. Clinical appearance is not a reliable prognostic indicator and the presence of acute and severe neurological signs does therefore not justify attributing a poor prognosis. This book will focus on how to become confident with neurology patients in clinical practice and how to differentiate between cases you can manage in clinical practice and those that will benefit from referral to specialist centres. Similar to other specialties, successful treatment can only be initiated after the most likely diagnosis has been identified. The most important diagnostic information is retrieved from aspects of the signalment, clinical presentation, general physical and neurological examinations. It is likely that the biggest hurdle in achieving a likely differential diagnosis is lack of confidence to perform a neurological examination. There is a tendency to unnecessary overcomplicate the clinical approach to neurology patients. This book will introduce the concept of clinical reasoning to improve your confidence and facilitate clinical decision making. Clinical reasoning is a cognitive strategy in which you consciously take a step back and focus on the most basic clinical characteristics of your patient to guide clinical decision-making. It allows you to recognise the most likely diagnoses after considering information from the signalment and clinical presentation. The secret to clinical neurology in practice might well be the art of breaking down seemingly challenging situations into easy-to-answer clinical questions. Specialist neurologists use clinical reasoning as a second nature and referred neurology patients do therefore not necessarily undergo advanced diagnostic imaging studies.
The aim of this book is to help you approaching common neurological presentations in practice. Although some of the most common conditions will be discussed, this book will not provide a detailed description of disease processes, will not discuss uncommon disorders, and will not detail diagnostic techniques or treatment options. This book is written for the veterinary practitioner who lacks confidence when having to assess neurology patients. It will give a practical overview on how to approach the most common neurological presentations and interpret diagnostic tools available in a first opinion-practice setting. Although clinicians with already a strong interest in neurology might find the contents of this book rather superficial, they might still find it interesting how the concept of clinical reasoning influences clinical decision making.
Prof. Steven De Decker