• evidence-based neurology

The delivery of good medical care is to do as much nothing as possible. (‘The House of God’, Shem1)

When, some 50 years ago, I embarked on a career in neurology, there were plenty of opportunities for doing nothing. Treatments were limited, investigations invasive, imprecise or both, and the specialty of neurophysiology is in its genesis. The consequence of this limited weaponry was that neurological education centred on listening, history taking, observing, examining and applying findings to a knowledge of pathologically based clinical localisation and physiology. Due to lack of numbers, the neurologist was a diagnostician who could provide limited treatments and was reliant on general medicine, or the family doctor, to provide on-going care to almost all the rare and most challenging of neurological conditions. How the landscape has changed, but is there now a place to practise a new and deliberate form of clinical inertia? The word ‘inertia’ sounds pejorative and implies a paralysis of activity; but this may not necessarily be true.

When it comes …