Closing the gap: relationships matter

The distance between neurologists and general practitioners has been dictated by history and politics but it is bad for patients and requires an innovative, professional response.

The crucial division between specialists and generalists in the UK was created during the years between the Apothecaries Act of 1815 and the Medical Act of 1858.1 The key triggers were the exclusion of GPs from hospitals and the establishment of the principle of referral. “The physician and surgeon retained the hospital but the general practitioner retained the patient.”2 Specialist physicians and surgeons, including neurologists and neurosurgeons, began the process of focussing their knowledge and skills on particular pathologies, a process which has led to enormous technical advances. Generalists remained close to their patients and communities and were able to observe the generation and progression of illness and disease within particular life contexts and stories. They developed a rich understanding of the inconsistent relationship between symptomatic illness and biomedical disease; between suffering and pathology. Whenever patients were referred to …