“Neurofobia”

… a detailed knowledge of neuroanatomy may not be essential for the practical management of patients with basic neurological problems. Indeed several authors have supported this idea and utilize the metaphor that “most people learn to drive safely with limited knowledge of how the engine works”.

(ZINCHUK, 2010.)

Apesar de não ter sido o inventor original do termo, Ralph F. Jozefowicz bem definiu a neurofobia no artigo Neurophobia: The Fear of Neurology Among Medical Students como:

… fear of the neural sciences and clinical neurology that is due to the students’ inability to apply their knowledge of basic sciences to clinical situations.

(JOZEFOWICZ, 1994.)

Existe um consenso nos vários artigos que discorrem sobre o assunto que a neurofobia seja um problema global, e eles mencionam diversas possíveis causas:

  • Necessidade de um maior conhecimento de Neurociências
  • Problemas do ensino na graduação
      didática inadequada
      tempo insuficiente
      pouca exposição ao assunto
      integração insuficiente da teoria com a prática
  • Complexidade do exame clínico
  • Complexidade dos diagnósticos; quantidade de doenças raras e/ou obscuras
  • Especialidade percebida muitas vezes erroneamente como proporcionando pouca ou nenhuma opção de tratamento

Além dos vários fatores acima relacionados como “causais”, é essencial uma compreensão do modus operandi do raciocínio e das condutas neurológicas, mesmo sem o conhecimento de todos os detalhes das ciências básicas, pois

An increasing number of patients with neurological diseases are managed by hospitalists and primary care physicians (PCPs). (…) Thus, it is critically important that current and future hospital and community based physicians are comfortable with and competent in the basic management of patients with neurological illnesses. Equally important is that hospitalists and PCPs recognize when a patient requires referral for specialized care.

(ZINCHUK, 2010.)

Muito do diagnóstico clínico neurológico depende da obtenção de dados de anamnese e exame físico, com filtragem ativa dos dados ao longo da avaliação, chegando-se a uma ou mais hipóteses iniciais. Devido ao elevado grau de diferenciação das várias partes do sistema nervoso, além do diagnóstico da doença em questão (dito diagnóstico sindrômico), outros componentes fundamentais compreendem:

  • Diagnóstico topográfico
    (a localização dentro do sistema nervoso)
  • Diagnóstico etiológico
    (a causa da doença, quando conhecida)

As citações do post Sherlock Holmes de 23/01/2021, enfatizando a importância do pensamento lógico para se chegar à solução do problema, valem também para a prática neurológica:

“The precise and intelligent recognition and appreciation of minor differences is the real essential factor in all successful medical diagnoses (…)”

(BELL apud WESTMORELAND e KEY, 1991.)

E:

“Like all other arts, the science of Deduction and Analysis is one which can only be acquired by long and patient study.” (A Study in Scarlet)
“It is a capital mistake to theorize before you have all the evidence.” (Idem.)
“We all learn by experience, and your lesson this time is that you should never lose sight of the alternative.” (The Adventure of Black Peter)
“It is of the highest importance in the art of detection to be able to recognize out of a number of facts which are incidental and which vital.” (The Reigate Squires)
“When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” (The Sign of the Four)
“A man should keep his little brain attic stocked with all the furniture that he is likely to use, and the rest he can put away in the lumber-room of his library, where he can get it if he wants it.” (The Five Orange Pips)

(WESTMORELAND e KEY, 1991.)

Bibliografia:

da Gama, Renato Faria. Neurofobia tem cura. Rev. Bras. Educ. Med. 2018;42(4):5-6.
Jozefowicz, Ralph F. Neurophobia: The Fear of Neurology Among Medical Students. Arch Neurol. 1994;51(4):328-9.
Lim, Erle C. H.; Seet, Raymond C. S. Demystifying neurology: preventing ‘neurophobia’ among medical students. Nat Clin Pract Neurol. 2008;4(8):462-3.
Santos-Lobato, Bruno Lopes; Barros Magalhães, Átila; Goes Moreira, Diego; Pinheiro Farias, Fredison; Porto, Lara Khaled; Pereira, Rodrigo Bentes; Custódio, Sávio Sérgio; Braga, Tiago Kiyoshi Kitabayashi. Neurofobia no Brasil: Detectando e Prevenindo um Problema Global. Rev. Bras. Educ. Med. 2018;42(1):121-8.
Tarolli, Christopher G.; Józefowicz, Ralph F. Managing Neurophobia: How Can We Meet the Current and Future Needs of Our Students?. Semin Neurol. 2018;38:407–12.
Westmoreland, Barbara F.; Key, Jack D. Arthur Conan Doyle, Joseph Bell, and Sherlock Holmes – A Neurologic Connection. Arch Neurol. 1991;48(3):325-9.
Zinchuk, Andrey V.; Flanagan, Eoin P.; Tubridy, Niall J.; Miller, Wendy A.; McCullough, Louise D. Attitudes of US medical trainees towards neurology education: “Neurophobia” – a global issue. BMC Medical Education. 2010;10:49.

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