Clinical skills are not necessarily impaired, but rather may be improved by ageing

V. Bonavita

University Federico II, Naples – Professor Emeritus of Neurology and President of Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy

Introduction. A clinician is an observer of nature, of a biased nature, an observer that cannot use Aristotle’s induction method, even as reviewed by Bertrand Russell, but rather the deduction method, as outlined by Albert Einstein and developed philosophically by Karl Popper, Pierre Duhem and by Augusto Murri –Popper’s ancient forerunner. One might also mention Antonio Cardarelli – a very intuitive clinician –a follower of Bertrand Russell and of the induction method. The ability to advance hypotheses may even be strengthened in time and as a practical experience enhanced upon ageing.

Successful old age and teaching. A clinician experiencing a successful old age is a wealth that should not be wasted in practice nor, perhaps, in teaching. The advantage of a well-preserved old man, also vs a clinician still far from his sixties, is then in the number of stories and, with respect to clinical semeiotics, in the skilfulness of the examination derived from long-term practice. The problem of the old man, besides losing his neurons, is the capacity of the cognitive reserve based on what Ernesto Lugaro – professor of nervous and mental disease clinics in Turin in the past century – called “neurotropism of the functioning neurons”, i.e. the tendency of neurons to form synapses. The challenge of learning the Information Technology language, grows with ageing and lastly, an old individual enjoys the well-known pleasure of paper communication.

Old clinicians and the general intelligence. A well-aged old clinician retains all the general intelligence developed in his or her youth, and continues to make the best use of it to set and solve problems.

Teaching clinics: true clinics, if not experienced as a practitioner, cannot be taught, nor preserved as a perennial intellectual asset of a well-aged old person (or well-made old person) echoing La tête bien faite by Edgar Morin.

Making a diagnosis. The problem here is still the warning of the clinician, of each one of us, that making a diagnosis means knowing a fragment of the real world of which we are part, and that knowing is only possible through a method. A well-made old person knows all this and must teach it through practice, which is also made of tiny observations that are not mentioned in treatises, but should be handed down verbally before they are lost. As Leonardo Bianchi noted in his last academic lecture on old age “we were and are excited about youth, it stimulated often my thoughts, it brightened up my existence year after year with spring fruits”.

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