Consequences of an oversupply of specialists for primary and specialty care: the case of neurology.
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Biomedical subjects
Publications and source records attributed to M Menken.
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Dexamethasone, compared to placebo in a double-blind study, failed to prevent the memory deficiency that typically accompanies electroconvulsive therapy (ECT) (n = 48 patients treated for DSM-III diagnosed major depressive disorder). Rather, the administration of the drug was associated with attention (p less than 0.02) and short-term memory (p less than 0.0003) difficulties in both bilateral and unilateral ECT patients. Bilateral ECT plus dexamethasone patients had significantly less improvement (p less than 0.05) in their depression (measured by the Hamilton Depression Scale) compared to bilateral ECT plus placebo patients. These depression differences were not seen among unilateral ECT patients.
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Among recent graduates of neurology training programs, a majority pursue careers in community practice. Because the scope of community neurologic practice differs from that of referral centers, I suggest five changes in postgraduate neurologic training: (1) instruction in an epidemiologic approach to patient care, (2) greater emphasis on training for ambulatory care, (3) development of departmental links with community hospitals, (4) clarification of the role of neurotechnology outside teaching centers, and (5) recognition of the need to regionalize some neurologic and neurosurgical care.
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