“When I was young I could remember everything, whether or not it really happened; now that I am in decay, I can only remember things that never happened.”

Mark Twain

Many years ago, I recall listening to a brilliant lecture given before a venerable medical society, delivered by a surgeon renowned for his wit. His address was acknowledged with the presentation of an elegant silver Elizabethan meat skewer. After a gracious response, he added that he would reserve its use exclusively for importuning demanding relatives who insisted on a second opinion. Nowadays, a remark of this kind would demand an abject apology dictated by a junior hospital executive, or a General Medical Council directive to be placed in the stocks.

With laudable, ever increasingly well informed patients and relatives and probable internet availability of a doctor's batting averages, there may well be more demands for second opinions. In addition, neurologists faced with complex clinical problems of diagnosis or management that cannot be resolved by Wikipedia may also wish for further advice. Who to approach may not be easy. For example, it can be frustrating to discover that an illustrious expert with great experience and many publications about a rare group of disorders may turn out to lack commensurate common sense, or worse, demonstrate embarrassing insensitivity by ignoring the patient.

This dilemma …