I think the most frustrating thing is the thought processes of a neurology attending since the advent of the MRI. In one hand you have the bread and butter Neurological exam: Someone's brain is potentially (whether in reality or not) different from baseline, so you call the neurologist to find out what is functionally wrong with this person's neuraxis, localize the lesion to a level/side/location if possible and then try to figure out what can cause that and devise your treatment plan. On the other hand...you could get an MRI and be done with the logical part.
The scary thing is that the neuro exam can be very wrong...and I've seen it in my short time on the service. We had a lady that came into the ED with what seemed to be unequivocally radiculopathic pain on exam. It looked like classic root compression with some pain and loss of sensory modalities...thanks for the $500 ED copay, do some PT for 6 wks and follow up. Well, within 24 hours she was a paraplegic without control of her bowel or bladder without sensation below the waist, enhancing lesions in the spine consistent with transverse myelitis. What causes it? We don't know 50% of the time. What's the prognosis? We don't know most of the time, but we're hopeful. What are the chances that I won't be bed ridden and incontinent? 60% that you'll improve, we're hopeful. It's tough to sit infront of a family and tell them that you're completely out of control of what is happening to them and you don't exactly know what will happen. I guess this is the most humble and useless that I've felt in a long time.
I don't think that I could walk into the hospital every day for the next 30 years to localize the leison, check to make sure I was right on the MRI and then have a role of the dice as to whether I can affect any change in the patient. Not to take anything away from them, neurologists are some of the most brilliant and logical physicians in the hospital dealing with a very complex system. I just couldn't see myself in their shoes.