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To the Editor: I was astonished to come across the Views & Reviews article by Landau and Nelson in a recent issue of Neurology.1 The authors pose as `common sense docs' restoring logic to a world gone awry. In fact, however, they offer little in the way of critical thinking and even less in terms of thorough analysis of the problem of caring for patients who want a real answer to why they fainted. Indeed, Landau and Nelson have entirely missed a key point. The issue is not whether physicians can make a `diagnosis' of the cause of syncope, but whether that diagnosis is right or wrong. In other terms, is the diagnosis sufficiently certain to permit confident and effective treatment, whether by reassurance, drugs, devices, or combinations of all these?
As has often been pointed out, syncope may be benign in many patients, but that is not the case in all. Our job is to sort …
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