The visit for a patient referred for evaluation by specialists tends to be organised around the convenience of the doctors rather than centred on the needs of the patient. We justify this in terms of efficient use of resources, although this may not always be the case. In an ideal world, all the diagnostic and evaluative resources would be made available to the patients in an integrated way that would enable them to join with their doctors in making an informed decision about treatment. In our own fields of neurology and neurosurgery the patient is generally referred for the individual opinion of the neurologist or neurosurgeon, rather than the evaluation process being centred on the patient. However, we believe that medical care can be improved when patients with problems that may require neurosurgery are evaluated by the neurologist and neurosurgeon—together.

At a few institutions this team approach has been developed where, in all cases, even the potentially “surgical” patient is first evaluated by the neurologist, and the neurosurgeon is consulted at the appropriate time in the evaluation. For example, for over a hundred years, physicians and surgeons at the Mayo Clinic have evaluated potential surgical patients together. As the distinct …