• Neuropathy

Neurophobia—the pathological fear of neurology—is a well recognised state of mind. This was first described in 19941 as occurring in medical students, and subsequently being demonstrated in junior doctors2 and around the world.3 ,4 While ‘neurophobia’ does not appear in the DSM-IV, the term does carry the implication that this is a disorder. However, as it is so widespread, occurring at all levels of training, across continents and through time, perhaps it should be regarded as the natural state for medical students and doctors. That certainly seems to be the presumption in many of the articles where it is discussed.2–4

In this article, I would like to explore a previously undescribed state, ‘neurophilia’, a love of neurology or more precisely a fascination by neurology. Moreover, I will argue that this is both widespread within medicine and the general population.

Neurophilia is probably a precondition to become a neurologist and presumably pretty much all the readers of Practical Neurology are afflicted. How can we assess this in other groups? One reasonable measure would be to look at how often neurological disorders feature in general medical forums—for example case reports—compared to other specialties and also to the burden of these different disorders within the population (figure 1). Analysis of Lancet case reports had neurology ahead of other specialties over two different time periods, 1996–2002, it was 29%5 and 2003–2008, 26%6; neurology accounted for 17% of BMJ case reports7—quite dramatic as neurology accounts for 5% of disease.7 On these measures, general physicians are closet neurophiles (figure 2).

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Figure 1

The percentages of case reports in the Lancet (mean from refs5 ,6), BMJ case reports and diagnoses on house classified by specialty,7 ranked by WHO disease burden.

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Figure 2

The number of books by specialty available on Amazon, classified by specialty and ranked by WHO disease burden.7

A similar preference for neurological topics was revealed in the analysis of the cases tackled by television maverick Dr House,7 where 27% of his cases were neurological, despite the character's training being putatively in nephrology and infectious diseases.8 The multiple awards of this television series and the duration of its run suggest wide public interest.8 More neurophilia.

Another measure comes from the online book seller.9 There are many more neurological titles available than other specialties, and again quite disproportionate when compared with the background burden of disease. In addition, books on neurological disorders account for 20 of their top 100 best sellers in internal medicine, four times as many as any other medical specialty (most on the list cover general topics). Publishers and book buyers seem to have a dose of neurophilia too.

Why does neurology make popular reading in journals and such entertaining television? As a committed neurophile, I could go on at length but presumably this is because of the range of stories in neurology; the fascinating and varied ways neurological disorders present, reflecting the complexity of the nervous system; and the emotional impact such disorders impart.7

How can we reconcile all this neurophilia with the repeated reports of neurophobia—especially in medical students and junior doctors? The disproportionate representation of neurological disorders in case reports and television reflects an interest in the topic, a fascination with neurological disorders. In journal case reports or television programmes, the readers or viewers are taken through the clinical scenario passively and the denouement is provided for them. Neurology is interesting to watch.

Neurophobia kicks in when medical students or juniors are asked to solve the problem themselves. They find neurology difficult and complicated, and feel they lack knowledge and skills.2 ,4 ,10 Neurophobia is thus a specific fear of personally doing neurology—despite their interest. This fear of doing neurology probably reflects the higher barrier to entry that there is for neurology. Students must know more and develop more sophisticated clinical skills to be able to begin solving neurological problems when compared with the first steps in other medical specialties.

The challenge for neurologists is to work out how to enable students and juniors to make that leap and gain that expertise and knowledge. We need to ensure that medical students get sufficient time to learn neurological skills during their undergraduate course—some UK courses provide a pitifully short time attached to neurology (Bain P, personal communication)—and that they are taught by neurologists who can pass on their neurophilia, rather than generalists who may pass on their own neurophobia. Effective (and inspirational) teaching,10 ,11 accessible textbooks and journals (such as Practical Neurology) are all important tools in bridging the gap, but perhaps we need to do more to exploit students’ latent but perhaps suppressed neurophilia.

Two simple steps could help. First, increased interaction with our general medical colleagues to kindle their latent neurophilia. Second, changing our image. Neurologists, in the past, have been caricatured as brilliant yet forgetful bow-tied intellectuals—perhaps we should reposition ourselves—emphasising that neurologists solve the same sort of clinical problems as Dr House, but politely, legally and without the limp.