Special care must be taken to avoid suggesting to the patient the symptoms that one seeks. The patient should be discouraged from framing his symptom(s) in terms of a diagnosis that he may have heard; rather, he should be urged to give a simple description— being asked, for example, to choose a word that best describes his pain and to report precisely what he means by a particular term such as dizziness, imbalance, or vertigo. Otherwise there is disposition on the part of the patient to emphasize aspects of the history that support a superficially plausible diagnosis. This problem is now amplified by the wide array of medical information available to patients through various sources such as the Internet. The patient who is given to highly circumstantial and rambling accounts can be kept on the subject of his illness by directive questions that draw out essential points. One should avoid suggesting terms to the patient, particularly those that prematurely confirm the physician’s preconceived diagnoses (“leading the witness”).
2.
The setting in which the illness occurred, its mode of onset and evolution, and its course are of major importance. One must attempt to learn precisely how each symptom began and progressed. Often the nature of the disease process can be decided from these data alone, such as the typical sudden onset of  stroke. If such information cannot be supplied by the patient or his family, it may be necessary to judge the course of the illness by what the patient was able to do at different times (e.g., how far he could walk, when he could no longer negotiate stairs or carry on his usual work) or by changes in the clinical findings between successive examinations.
3.
In general, one tends to be careless in estimating the mental capacities of patients. Attempts are sometimes made to take histories from patients who are cognitively impaired or so confused that they have no idea why they are in a doctor’s office or a hospital. Young physicians and students have a natural tendency to “normalize” the patient’s cognitive performance, often collaborating with a hopeful family in the misperception that no real problem exists. This attempt at sympathy does not serve the patient and may delay the diagnosis of a potentially treatable disease. A common error is to pass lightly over inconsistencies in history and inaccuracies about dates and symptoms, only to discover later that these flaws in memory were the essential features of the illness.
4.
Asking the patient to give his own interpretation of the possible meaning of symptoms sometimes exposes concern, depression, anxiety, suspiciousness, or even delusional thinking. This also may allow the patient to articulate fears about certain diseases such as brain tumor, dementia, motor neuron disease, or multiple sclerosis. Exposing these fears allows the physician to allay these concerns forthrightly.
The neurologic examination begins with observations in the waiting room, and continues as the patient proceeds to the examination room and while the history is being obtained. The manner in which the patient tells the story of his illness may betray confusion or incoherence in thinking, impairment of memory or judgment, or difficulty in comprehending or expressing ideas. A more extensive examination of attention, memory, cognitive ability, and language is undertaken if the history or the manner in which it is given indicates the problem lies in those spheres. Otherwise, asking the date and place, repeating and recalling words, and simple arithmetic are adequate screening procedures. One then proceeds from an examination of the cranial nerves to the testing of motor, reflex, and sensory functions of the upper and lower limbs. This is followed by an assessment of gait and station (standing position) are observed before or after the rest of the examination.