• CLINICAL NEUROLOGY

Until recently, most neurological physicians were general neurologists, but neurology is rapidly becoming subspecialised. The American Academy of Neurology website lists 27 subspecialties with available fellowships.1 Compston predicted that eventually there would be four types of neurologist: general neurologists working outside a main centre; subspecialists in a main centre who are competent in general neurology; super-specialists who seldom venture outside their area of expertise; and full-time researchers who seldom see a patient.2 Neurologists working in small hospitals or in solo practice unavoidably must be general neurologists, but even in large hospital departments, those with a subspecialty interest often act as general neurologists and see new patients. Many subspecialists are excellent general neurologists and—though often reluctant to admit it—they likely have more enjoyment from the intellectual challenge of general neurology than their chosen field of expertise.

The benefits and drawbacks of general neurology can be considered from the viewpoint of the neurologist and that of the patient.