Lombardia

Lombardia is a busy and industrial northern Italian region with 9 million habitants and about 400 neurologists, but it is surrounded by beautiful lakes and mountains easily reached from Milano where we all live. We are three neurologists—Patrizia, Livia and Cristina (fig 1)—and we invite you to spend a day with us at work. As you can see from our photograph, we are old enough to have seen the changes in Lombardia’s regional health system over the last 10 years, but young enough to have tried to make them work. Our female point of view could be biased, but women are becoming the majority of neurologists in Milano (fig 2).

PATRIZIA

I work at Legnano hospital which has 800 beds for about 400 000 inhabitants. I start my usual day at 8 am by visiting the 26-bed neurology ward to see the newly admitted patients, usually from the emergency department (about three per day). Then I see the two or so day-hospital cases who come every day into our four-bedded unit for investigations. We have to be quick ordering their investigations, as other patients already on the ward are waiting for their previous-day investigation results. Frequently I have to go down the three floors to the neuroradiology department to see and discuss MR and CT scans, and consult with the cardiologist or internal physician on the phone, and sometimes with the neurosurgeon too. All this takes me about four hours and by noon I should be ready to discharge patients, and write their discharge letters.

In the last few years this process has become more and more complex and time consuming. For dependent cases I have to fight for a bed with doctors at the rehabilitation hospitals which are always full, or with home rehabilitation services, and I have to convince …