Preventing neurophobia in medical students, and so future doctors

Although neurophobia is a longstanding problem, it has only recently been given the name. In 1994, Jozefowicz, an American neurologist, described it as “a fear of the neural sciences and clinical neurology” held by medical students and doctors.1 This fear can lead to paralysis of thinking or action. Neurologists on both sides of the Atlantic will be familiar with referrals from medicine or psychiatry of patients with questions like “? organic brain ?”. Other patients, who have not previously been referred, but who clearly have neurological signs, have a clinical record in which the examination reads “CNS NAD”. Neurologists have come to infer that this acronym for “Nothing Abnormal Demonstrated” can equally mean “No Assessment Done”.

Fear of neurology and avoidance of the examination of the nervous system is not only a problem for hospital specialists. It pursues medical graduates when they go out to practice in the community. Epilepsy is one of the commonest neurological conditions managed by general practitioners (GPs).2 And patients generally prefer receiving epilepsy care mainly from their GP.3 Indeed, in the UK, the Department of Health endorsed the importance of monitoring epilepsy in general practice by payments which are linked to standards set by the Quality and Outcomes Framework.4 However, when Thapar et al surveyed GPs, they found that GPs rated as low their confidence and competence to manage this common condition.5 In interviews, GPs also expressed lack of confidence in managing other common neurological conditions, like Parkinson’s disease and headache.6,7 There is simultaneous evidence from patients that lack of confidence in neurology leads GPs to avoid providing advice on the social aspects of the condition—like fitness to work, driving and eligibility for benefits.6,8

It has been an in-joke among neurologists that outsiders feared their subject …