Focus on the ‘art’ of clinical neurology and bridge basics with futuristic trends
Stressing on need to safeguard free health, equity and the public health system, ASN President sends out appeal
Bridging the basics with futuristic trends is what the 16th President of the Association of Sri Lankan Neurologists (ASN), Dr. Darshana Sirisena is promoting having taken on the mantle in April last year when the country was recording the “most extreme” adverse living conditions.
He assured the distinguished gathering at the inauguration of the ASN’s annual congress on the theme ‘Bridging basics with futuristic trends in neurology’ on Friday in Colombo that the congress would be “unique” and that despite the triple whammies of social-economic-political instability, the ASN has had a productive year.
The Chief Guest was ASN’s Founder President Prof. Ranjanie Gamage, dubbed the “matriarch” in Sri Lanka in the crusade for epilepsy, who spoke on ‘Interphase of mind, brain and religious philosophies’. The Guests-of-Honour were Professor Emeritus of Medicine, Faculty of Medicine, University of Kelaniya, Prof. Janaka De Silva and President-Elect of the World Stroke Organization, Prof. Jeyaraj Pandian.
With pride tinged with humility, Dr. Sirisena underscored that four leading global neurology bodies – the World Federation of Neurology (WFN); the International Parkinson’s and Movement Disorders Society; the International Headache Society; and the Asian Regional Consortium for Headache partnered with the ASN and endorsed the congress.
Delving deep into the specialty of neurology, he said that rapidly evolving technology including high-end imaging of the nervous system and advances in immunology have made their job easier. Yet, the basic history-taking and examination in neurology cannot be replaced merely by state-of-the-art technology and investigations.
“It is unfortunate that we frequently witness an MRI (Magnetic Resonance Imaging) of the lumbar spine being prescribed for patients with spastic paraparesis (difficulty walking due to muscle weakness) without any justification. Similarly, a nerve conduction study is unnecessarily ordered for patients with flaccid paraplegia with a thoracic sensory level,” lamented Dr. Sirisena, stressing that this is where they have to bridge the basics with futuristic trends. Basic history taking and examination with the intention of developing a differential diagnosis based on that information cannot be replaced by any other investigation, irrespective of how sophisticated it is.
He went onto explain that clinical neurology is an “art”, where you observe all clinical signs in front of your very eyes, unlike having the advantage of keeping a stethoscope on a patient’s chest and analysing what is heard. The focus should be on interpreting and identifying the patterns and answering three simple questions – What is the lesion? It could either be upper or lower motor neuron (UMN or LMN) or a combination. What guides you to decide wherethe lesion is either in the central nervous system (CNS) or peripheral nervous system (PNS) and finally the question: Why?We aim at aetiology and confirmation by investigations which could be simple or very sophisticated.
Moving on to applying these questions to Sri Lanka’s health system which is “unique”, he said that this reputation is at stake currently. What has been the investment to achieve this unique status? According to World Bank statistics, Sri Lanka, when compared to other countries which have similar indices, has invested minimum in health. Some are of the view that though indicated even this amount is not invested in practice. Then how could we sustain all these and remain almost on par with more privileged economies? This is due to the three factors of: free health, equity and the public health system.
“Any citizen irrespective of gender or social status can access a government health institute. Any one of the 1,103 hospitals spread across the country can be reached within an hour. Thereafter, the whole healthcare process is done free of charge by the government. Though we face a huge crisis at present in providing healthcare due to the prevailing economic crisis, no matter what challenges we face, we must uphold the 3 concepts mentioned previously. At times, I feel that the free health system is taken for granted. I hope that professional colleges will play a more significant role in this arena,” added Dr. Sirisena.