Mysterious art of Russian neurology

[yananshs]

Why so many neurologic diagnoses in Eastern European referrals? Some possible reasons:


1.Russian medicine tends to list issues that we might consider "risk factors" or "things to watch for" as diagnoses (thus, lack of prenatal care can become "risk for intrauterine infection")
2.many diagnoses are provided by specialists and hospitalists, notoriously the neurologists, many of whom seem to have "favorite diagnoses", and incentives to overdiagnose in general
3.a persistent Soviet-era pessimism about the birth process; even with a (to us) healthy delivery they are quite worried about interruptions of blood and oxygen to the baby's brain, kinking of the spinal cord, and so on ... their descriptions of the birth process (and occasional interpretations of newborn spinal xrays) can leave one marvelling that babies are born with their heads still attached
4.a tendency to interpret what to us are normal, immature newborn behaviors (startle reflex, trembling chin, mottled skin, belching, etc) as signs of neurologic damage
5.and a subsequent tendency to ascribe what we might call normal infant maturation to recovery from neurologic illness, thanks to massage, medications, supplements, and other typical treatments
6.when it comes to orphanage-raised children (who, admittedly, do come from higher-risk backgrounds), there may be a bit of cultural pessimism about outcomes

Or, on the 'flip' side:

"Sometimes they diagnose just to show they care ..."
"It's all just a big jobs program for Russian neurologists."
"This diagnosis, in Western terminology, means that the child was born in Russia."
"It's the 'shotgun' approach to diagnosis - if you label all the children with neurologic impairments, you can rest easy that you haven't missed any of the actual diagnoses."



Essentially, the pediatricians are found to be dedicated and proud of their work, but hampered by antiquated, unproven protocols that over-diagnose, over-test, and over-medicate young children
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