The purpose of an exercise in differential diagnosis is to establish crosslinks between medical facts stored in different sections of our memory.
This book, Differential Diagnosis in Neurology, is the unified perspective of an eminent physician with decades of clinical experience and teaching; one of the most skilled clinical neurologists of modern times and a seasoned researcher who was the primary investigator for many clinical trials, and who published numerous clinical and basic research papers. The “real world” aspects of the book are based on morning reports with neurology residents and students conducted over 40 years. The differential diagnosis generated by subspecialty division chiefs supplemented those proposed in morning reports.
The book is conceived as a guide that will give the clinician a concise snapshot or skeleton with a general background of the disease at hand. Other disease aspects included in this book are molecular genetics, physiology, and biochemistry that will elucidate mechanisms and assist in discovering new entities. Each chapter includes an extensive list of suggestions for further reading.
It is the art of crosslinking between medical facts that distinguishes Dr. Schwartzman from other teachers of Neurology and that makes this book uniquely valuable.
"The essence of a differential diagnosis is ‘splitting’ rather than ‘lumping’: it requires bringing knowledge to the table and then adding experience." - R.J. Schwartzman
Dr. Robert Schwartzman’s book entitled Differential Diagnosis in Neurology is unique in many ways. It is written by one of the most skilled clinical neurologists of modern times; someone who devoted his entire career to teaching the art of Neurology to generations of residents and students; someone who shaped the field of Neurology to become an independent specialty but never stopped teaching it in the greater context of Internal Medicine.
Dr. Schwartzman’s unique way of teaching Neurology is reflected in this book. Every day as a Neurology resident in his program started with Morning Report – an hour of case review, differential diagnosis, discussion of diagnostic studies and treatment combined with quizzing the residents on pertinent literature, new and historical alike. It is here where the foundation was laid to taking the best possible care of our patients throughout the rest of the day. One of the most valuable experiences in morning report was the exercise in differential diagnosis, an aspect of clinical medicine that in the times of ever-increasing sub-specialization and reliance on “handheld” knowledge is at great risk of becoming extinct.
Writing a book on differential diagnosis is probably one of the most difficult tasks in academic medicine. By nature, these writings ought to be monographs as they reflect an individual style. The purpose of an exercise in differential diagnosis is to establish crosslinks between medical facts stored in different sections of our memory – sections that unless accessed through the same channel we learned them are irretrievable. It is the art of crosslinking that distinguishes Dr. Schwartzman from other Neurology teachers and that makes this book uniquely valuable. It helps you see the forest in spite of all the trees, the bigger picture, the bird’s eye view.
Admittedly, I’m biased. I can truly say that my career has been shaped by Dr. Schwartzman and his way of teaching Neurology. Without him, I would have become a different Neurologist or maybe not a Neurologist at all. Differential Diagnosis in Neurology makes accessible his way of thinking, analyzing, and teaching to a much broader audience.
The book is organized by neuroanatomical structures. A separate chapter is devoted to epilepsy. For each level within the hierarchy of the nervous system and the vascular tree, neurologic syndromes are listed and their differential diagnosis is outlined. The depth and breadth with which these syndromes and differential diagnoses are described is one of a kind. In addition, the reader is provided with an unprecedented plethora of clinical tricks and secrets. The mostly tabular form of the book is the only way to fit such an abundance of information in a single book. While the book does not contain citations, most of the facts can be easily tracked in the literature. By not providing citations, Dr. Schwartzman honors some of his core principles in neurologic education: teaching by stimulating and challenging, avoiding the “Nuernberger Trichter” (Nuremberg funnel) method, using the competitive interplay between teacher and student.
The student and junior resident have to study this book, not read it. It does not prepare you for the board exam in the most efficient way but for life as a Neurologist. More experienced neurologists will find it to be a valuable when confronted with a difficult patient. Take on the challenge! It will be a transforming experience.
Joachim M. Baehring, MD
Associate Professor of Medicine (Medical Oncology), Neurology, and Neurosurgery
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