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Neurologists ‘suited and booted’ and not a desk in sight
  1. Ann Johnston
  1. Correspondence to Dr Ann Johnston, Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK; jannjohnston{at}

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I agree that when neurologists sit at a desk they do more than simply sit behind a desk.1 However, newly appointed neurologists may ask, ‘What is a desk?’ The era of comfortable, ordered and controlled neurology where patients attend the relative calm of the outpatient clinic is passing as neurology moves closer to the front line.

Contrary to comfortable neurology— seated at desk with coffee and biscuit to hand—modern neurology is delivered by neurologists who are ‘suited and booted’ in the medical admissions unit, surrounded by bleeping drip stands, the chatter and clatter of bins and doors and the wafting aroma of urine, toast and melaena. Although there is now rarely a pin stripe or a bow tie in sight, most neurologists are ‘suited’ (taking pride in their appearance, keen to demonstrate they are not just cerebrally smart) and ‘booted’ (ready for action, kit bag in hand, equipped with tendon hammer and ophthalmoscope) and in action in the emergency unit. Pretending we are superheroes might be over-egging it. However, the role is only complete with hot lines to the scanner and to our new best friend (the approachable, amenable, pliable radiologist) and direct access to the hot follow-up clinic, which, if it had a desk, would be a hot one.

When asked what do neurologists do, the answer lies in what do we not do. We take on and engage with many new services, such as acute stroke and thrombolysis, first seizure and transient loss of consciousness clinics, acute headache services with botulinum toxin and greater occipital nerve injections, while continuing our established workload of general neurology and management of chronic neurological diseases, not to mention research and teaching commitments. If we move any closer to the front line we might have a new specialty of car park neurology. So when asked what do neurologists do, relating the real list of our jobs and responsibilities might take longer than finding a tendon hammer or ophthalmoscope in the emergency unit (so it's best to be ‘booted’ at all times).

Figure 1

Familiar sights and sounds in the admissions or emergency unit.

Our role is still something different from other specialists, whether at a desk or on the feet, and I suspect this lies in our training, our expertise and our attention to detail, revealing, dare I say it, a personality trait. However, broadening and expanding our roles generally reflects that we are an affable group, keen to engage, keen for new challenges and keen to step up when needed to do what is best for our patients, based on the best available evidence. So although desks as a commodity are in decline, whether seated at one in the outpatient clinic, or on our feet in the emergency unit, we do make a difference.


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  • Competing interests None.

  • Provenance and peer review Not Commissioned; internally peer reviewed.

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