Why can’t I make neurological diagnoses anymore?

A few years ago, I attended my first Movement Disorders Society conference in the USA (yes it was courtesy of the pharmaceutical industry, no I cannot remember which company, but no doubt I have used their drugs regularly since). During an interactive session, the audience was asked to indicate whether they were movement disorders doctors, neurologists or “other”. I had no idea there was such a thing as a pure movement disorder doctor, although more recently it came to my attention that in-patient neurology is also seen as a subspeciality in the USA, so things are a little different over there. Nonetheless, this conference introduced me to the concept of the superspecialist (or is that subspecialist?)

When asked what sort of neurologist I am, I proudly describe myself as a generalist. True, I run or participate in a number of “specialist” clinics where patients with particular disorders are gathered together, often to be seen by a multidisciplinary team with immediately available specific investigations. These include clinics for first seizures (or “first attacks” as more pedantic colleagues prefer), movement disorders, unruptured aneurysm screening, subarachnoid haemorrhage follow-up and Huntington’s disease, but I spend most of my week wading through “general neurology”. However, my answer increasingly seems to disappoint patients, who are gradually being persuaded that their problem deserves a “real” specialist, not me.

In the UK, we have avoided the generalist versus specialist versus superspecialist debate for years by cunningly ensuring we have insufficient doctors at every level. The populations of Denmark and Scotland are roughly the same, …