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PubMed2003

Treatment of epilepsy in general hospitals: do patients and neurologists agree on success or failure?

OBJECTIVE: Opinions of patients and neurologists about aspects of their epilepsy and their treatment were compared. METHOD: Thirty-two neurologists, working in general hospitals, included 198 patients aged 16 years or more. Both neurologist and patient independently completed a questionnaire consisting of simple open questions about the epilepsy and the drug treatment. The average characteristics for this group are very similar to characteristics of the general population: age and gender distribution, highest completed educational level, occupational participation and family circumstances are not statistically significant from the general population. RESULTS: Neurologists and patients appear to agree about most areas that we assessed: seizure count, severity of epilepsy, efficacy and tolerability of the treatment and impact of the epilepsy and treatment on daily life (as expressed in the 'Quality of Life ratings'). Detailed analysis showed that this agreement is partly artificially increased by the group with good outcome and less strong or even absent for the more severe epilepsies. For seizure count, we see 96.4% agreement for the group with low seizure frequency and 73.1% agreement in case of high seizure frequency. For the evaluation of severity of the epilepsy, 73.2% agreement is found for mild classification and 16.6% agreement for the severe classification. Agreement on Quality of Life (QOL) is almost complete in patients with excellent QOL (91% agreement) and almost absent for a low QOL (17% agreement). Finally, the same pattern is found for reports on side-effects of the medication. Both neurologists and patients report side-effects in about 40% of the cases. This suggests excellent agreement but individual data show that agreement is only satisfactory for the milder epilepsies (16.2% vs. 16.2%). For the more severe agreement is almost absent (4.1% of the neurologists vs. 13.4% of the patients). DISCUSSION: Possibly, it is more difficult for the neurologist to perceive and appraise all relevant factors in the case of complex epilepsies. Alternatively, subjective definitions and assumptions of patients differ from the standards set by the neurologists in the case of continuing seizures. The clinical relevance of our findings is that, especially in the cases of more severe and refractory epilepsies, patients' opinions are of utmost importance and we cannot take our own opinions and evaluations at face value.

Adolescent↗

PubMed1998

Use of corticosteroids in multiple sclerosis by consultant neurologists in the United Kingdom.

OBJECTIVES: To survey the use of corticosteroids in multiple sclerosis as recommended by United Kingdom consultant neurologists. METHODS: A postal questionnaire covering the use of corticosteroids for acute multiple sclerosis relapse and chronic progressive multiple sclerosis with regard to frequency of use, type of corticosteroid, and dosage regime was sent to all members of the Association of British Neurologists with a United Kingdom address. RESULTS: Two hundred and twelve United Kingdom consultant neurologists replied to the survey (74% response rate). Eighty six per cent indicated that they prescribed corticosteroids in more than one quarter of acute multiple sclerosis relapses seen. Intravenous methylprednisolone was recommended at some time by 99% of consultant neurologists, the most popular regime being 1g daily for 3 days (74%; 154/ 208). Over one half (53%; 109/206) never recommended a subsequent tapering course of oral corticosteroids; of those that did, 25% (24/96) recommended a tapering course lasting more than 1 month. Eighty eight per cent (1811206) of prescribers of intravenous methylprednisolone were able to offer the course as a day case on the ward; 7% (151206) at an outpatient clinic; and 5% (111206) at home. Almost three quarters of neurologists recommended oral corticosteroids for some acute relapses, although the most popular response was for occasional use only (48%; 1011212). Forty five per cent (961211) at least occasionally recommended steroids for patients with chronic multiple sclerosis not experiencing an acute relapse. CONCLUSIONS: Although the vast majority of consultant neurologists would prescribe intravenous methylprednisolone for acute multiple sclerosis relapse at some time, the use of corticosteroids for multiple sclerosis was otherwise variable. There seemed to be little consensus about the use of oral steroids in acute relapse, the prescribing of a tapering course of oral steroids after intravenous methylprednisolone, or the utility of steroids in chronic multiple sclerosis. Variability of prescribing recommendations probably reflects a lack of clear evidence in the face of a wide range of clinical situations, variable access, and timing of access to neurologists in the acute phase of relapse and pressure on neurologists to treat in an otherwise "hopeless" situation. Large multicentred trials are needed to consider these issues.

Administration, Oral↗

PubMedDate not supplied

Interrater reliability of the National Institutes of Health Stroke Scale: rating by neurologists and nurses in a community-based stroke incidence study.

The reliability of the National Institutes of Health Stroke Scale (NIHSS) for use by trained neurologists in clinical trials of acute stroke has been established in several hospital-based studies. However, it also has the potential for application in community-based settings and to be used by nonneurologists: issues which have not been explored before. Hence, we aimed to determine the reliability of the NIHSS when administered by research nurses within the existing North Eastern Melbourne Stroke Incidence Study. Using the NIHSS, thirty-one consecutively registered stroke patients were assessed by 2 neurologists and 1 of 2 trained research nurses. The interrater reliability of observations was compared using weighted and unweighted kappa statistics and intraclass correlation coefficients (ICC). There was a high level of agreement for total scores between the 2 neurologists (ICC = 0.95) and between each neurologist and research nurse (ICC = 0.92 and 0.96). While there was moderate to excellent agreement among neurologists and research nurse (weighted kappa > 0.4) for the majority of the NIHSS items, there was poor agreement for the component 'limb ataxia'. Overall, agreement between nurse and neurologist for individual items was not significantly different from agreement between neurologists. It appears that in both hospital and community settings, trained research nurses can administer the NIHSS with a reliability similar to stroke-trained neurologists. This ability could be used to advantage in large community-based trials and epidemiological studies.

Australia↗

PubMed1996

Antiepileptic medication and oral contraceptive interactions: a national survey of neurologists and obstetricians.

Hepatic enzyme-inducing antiepileptic drugs (AEDs) lower oral contraceptive (OC) sex hormone levels approximately 40% and increase the risk of unplanned pregnancies in women with epilepsy. AEDs also increase the risk of birth defects in offspring of women with epilepsy. We performed a national survey to determine obstetricians' and neurologists' knowledge of OC and AED interactions and the risk of birth defects for women with epilepsy taking AEDs. We received responses to a mailed questionnaire from 160 of 1,000 neurologists (16%) and 147 of 1,000 obstetricians (15%) from 47 states. Practice demographics and ages of responders were typical for U.S. neurologists and obstetricians. Ninety-one percent of neurologists and 75% of obstetricians said they treat women with epilepsy of child-bearing age. Only 4% of the neurologists and none of the obstetricians, however, knew the effects of the six most common AEDs on OCs, even though 27% of neurologists and 21% of obstetricians reported OC failures in their patients taking AEDs. Although increasing OC doses can compensate for insufficient OC sex hormone levels due to AEDs, most physicians do not increase the doses. Even though the risk of birth defects for the offspring of women with epilepsy is 4 to 6%, up from the background level of 2%, 44% of neurologists thought the risk was lower (0 to 3%), and some of the respondents guessed that it was as high as 50%. Many neurologists and obstetricians do not have accurate information to counsel women with epilepsy properly about their contraceptive and pregnancy choices.

Abnormalities, Drug-Induced↗

PubMed1998

Practice styles of US compared to UK neurologists.

OBJECTIVE: This study assessed variation between neurologists in the United States and United Kingdom in their diagnostic and treatment decisions for commonly encountered neurologic presentations, and identified explanatory factors for any observed variation. METHODS: All 210 consultant neurologists in the United Kingdom and a nationally representative sample of 595 US neurologists received mailed surveys containing three detailed clinical scenarios depicting patients with (1) a single unprovoked seizure occurring 3 days previously, (2) early Parkinson's disease, and (3) dementia. The main study outcome measures were self-reported decisions regarding diagnostic test ordering and treatment, which were assessed after each scenario. Neurologists' practice characteristics, certainty about the diagnosis, and attitudes toward uncertainty were also measured. Survey response rates were 92% of US and 63% of UK neurologists. RESULTS: A higher proportion of US than UK neurologists indicated they would order additional diagnostic tests for all three scenarios (all p < 0.05); 77% of UK compared with 26% of US neurologists would manage a single unprovoked seizure without antiepileptic medication (p < 0.0001), but treatment of early Parkinson's disease was not different. Nearly all US and UK neurologists would obtain a neuroimaging study in the evaluation of dementia. International differences persisted after adjustment for differences in demographic and practice characteristics and for attitudes toward test use and clinical uncertainty. CONCLUSIONS: We identified large international variation in clinical decisions across three common neurologic conditions. Cross-country collaboration should explore these differences to develop consensus on standards of care.

Attitude of Health Personnel↗

PubMed2006

[Survey on the current situation of the young neurologists in Spain: analysis of their current working stability and degree of social protection].

INTRODUCTION: The aims of this study were to evaluate the working stability and degree of social protection of the Spanish young neurologists, and to know their opinion about their own situation. METHODS: The 343 neurologists that became specialists in Spain between 2000 and 2004 were asked to participate in two consecutive surveys. The first, conducted online, included questions about the availability to change the place of work and the opinion about the situation of young neurologists, and obtained 66 answers. The second was a telephonic and online survey, answered by 217 neurologists, whose questions referred to: places of neurological education and work, type of working contract, and degree of social protection (estimated by the percentage of worked time during which they paid Social Security contributions). RESULTS: Sixty-three per cent (136/217) of the Spanish young neurologists had an unstable job. The most frequent unstable working contracts were: eventual (n=65; 31%), on-call contracts (n=54; 25%) and grants (n=53; 24%). Forty-eight per cent of the neurologists who ended their specialization in 2000 still remained working-unstable. The mean percentage of worked time with full social protection was 71.01+/-36.74%. Less than a half (n=101; 46%) had social protection during the entire worked time, 60 (28.6%) were socially protected during <50% of the worked time, and 23 (11%) never had social protection. A direct relationship was observed 68 between working instability and lower social protection (p=0.0002). The working situation of the Spanish young neurologists was seen as problematic by 97% of the 66 participants in the first survey. CONCLUSIONS: The current situation of the Spanish young neurologists, attending their working stability and degree of social protection, seems precarious and problematic. Urgent actions should be taken by the Administration to improve it.

Data Collection↗

PubMed2006

The influence of provider sex on neurologists' annual incomes.

OBJECTIVE: We sought to determine the influence of provider sex on neurologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. METHODS: We used survey responses collected throughout the 1990s from 216 actively practicing neurologists and linear regression modeling to determine the independent influence of provider sex on neurologists' annual incomes. RESULTS: White female neurologists reported seeing 11% fewer visits and working 6% fewer annual hours than their white male counterparts. White female neurologists had practiced medicine for fewer years than white males (p = 0.01). In addition, females were less likely to be employees, as opposed to having an ownership interest in the practice, and were more likely to be board certified, though not statistically significantly so. After adjustment for work effort, provider characteristics, and practice characteristics, white female neurologists' mean annual income was 165,321 dollars, or 47,854 dollars (22%) lower than that for white males (95% CI: 82,710 dollars lower to 12,997 dollars lower, p = 0.007). CONCLUSION: During the 1990s, female sex was associated with lower annual incomes among neurologists. Just as policymakers are exploring sex differences in access to and outcomes health care, they should further explore these findings to ensure that income differences among physicians who provide that care are not unjustly driven by provider sex.

Certification↗

PubMed2003

Agreement among neurologists on the clinical diagnosis of dystonia at different body sites.

OBJECTIVE: To study the reliability of the diagnosis of blepharospasm, oromandibular dystonia, cervical dystonia, and writer's cramp among neurologists. METHODS: 12 patients with adult onset focal segmental dystonia were videotaped in a standardised way. The tape was sent to six neurologists who are involved in clinical practice without a specific interest in movement disorders (general neurologists), and to four neurologists expert in movement disorders. The observers had to recognise whether the patients were affected by dystonia and to distinguish among blepharospasm, oromandibular dystonia, cervical dystonia, and writer's cramp. Interobserver reliability was assessed by kappa statistics, and the degree of agreement was classified according to the Landis classification. RESULTS: The 10 neurologists reached slight to moderate agreement on the diagnosis of these four disorders. When the observers were subdivided according with their professional experience in the field, a moderate to perfect agreement on the diagnosis was achieved by specialists in movement disorders, and a fair to moderate agreement by the general neurologists. CONCLUSIONS: Neurologists may have different ability to recognise adult onset focal dystonia, depending on their experience and on the type of dystonia.

Adult↗

PubMed2003

Impact of emergency room neurologists on patient management and outcome.

UNLABELLED: The frequency and impact of in-patient assessment by a neurologist in the emergency room (ER) setting remain largely underestimated. The objective of our study was to analyse the impact of neurologist in-patient management. METHODS: Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the ER, the ER team's tentative neurological diagnosis, the neurology team's final diagnosis and patient outcomes. The time interval between admission, call for a neurologist and the assessment by the neurologist were recorded. RESULTS: Assessments by neurologists were performed in 14.7% (1,679/11,421) of all patients admitted to the ER. The mean time between admission and examination was 32 (+/- 36) min, irrespective of the day of the week, and dependent on the tentative diagnosis: shorter for stroke and status epilepticus (p < 0.05) and longer for confusion and vertigo (p < 0.05). The initial causes for examination were: stroke (33.1%), epilepsy (20%), loss of consciousness (9%), headaches (9%), confusion (5.4%), peripheral nervous system disorders (4.4%), vertigo (4.2%), cognitive dysfunctions (4%), gait disorders (3.2%) and miscellaneous (7.1%). Overall, false positive or negative diagnoses were produced by the ER in 37.3 and 36.6% of ER admissions, respectively. A complete change of diagnosis by the neurologist was found in 52.5% of patients. Of the patients undergoing a neurological examination, 18.4% were able to go home, 31.8% were admitted to the stroke unit, 32.4% to the general neurology unit and 17.4% to other departments. CONCLUSION: Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.

Brain Diseases↗

PubMed1999

General neurologist and subspecialist care for multiple sclerosis: patients' perceptions.

OBJECTIVE: To compare general neurologists and MS specialists on patients' clinical characteristics and MS care as perceived by patients with MS. METHODS: We sampled all adult patients with MS having physician visits over a 2-year period from a Midwestern managed-care organization and from the fee-for-service portion of 23 randomly selected California neurologists' practices. In mid-1996, 694 subjects were mailed questionnaires; 532 (77%) responded. Sociodemographic/clinical characteristics, recent utilization of services/treatments, unmet needs, symptom care, and research participation were measured. Of 502 subjects (94%) who indicated their usual physician providing MS care was a neurologist, 217 (43%) reported having a general neurologist and 285 (57%) reported having an MS specialist. Comparisons between these two groups were adjusted for comorbidity and disease severity. RESULTS: General neurologist and MS specialist patient groups did not differ on any sociodemographic or clinical characteristic except age (p<0.05). Although health care utilization generally was similar, higher proportions of the MS specialist group were aware of or had discussed interferon beta-1b (IFNbeta-1b) with their physician (p<0.05) and were currently taking it (p<0.05); a smaller proportion of the MS specialist group reported stopping it because of side effects (p<0.01). Overall, levels of unmet need and care for recent symptoms were similar, but the MS specialist group reported more confidence in their physician/carefulness in listening (p<0.05). Twice as many MS specialist subjects had participated in nondrug research (p<0.05); drug study participation was similar. CONCLUSIONS: Patients' perceptions of their care were similar in most ways for those who designated their main MS provider as a general neurologist compared to an MS specialist; however, care differed in potentially important areas. Prospective, longitudinal studies are needed to measure and relate neurologists' training, experience, knowledge, and MS patient volume with both process and outcome measures of quality of MS care.

Adult↗

PubMed2000

US neurologists: attitudes on rationing.

OBJECTIVE: To assess neurologists' attitudes on rationing health care and to determine whether neurologists would set healthcare priorities in ways that are consistent with cost-effectiveness research. BACKGROUND: Cost-effectiveness research can suggest ways to maximize health benefits within fixed budgets but is currently being underused in resource allocation decisions. METHODS: The authors surveyed a random sample of neurologists practicing in the United States (response rate, 44.4%) with three hypothetical scenarios. Two scenarios were designed to address general attitudes on allocating finite resources with emphasis on formulary decisions for costly drugs. The third scenario was designed to assess whether neurologists would optimize the allocation of a fixed budget as recommended by cost-effectiveness analysis. RESULTS: Three-quarters of respondents thought that neurologists make daily decisions that effectively ration healthcare resources, and 60% felt a professional responsibility to consider the financial impact of individualized treatment decisions on other patients. Only 25% of respondents thought that there should be no restrictions placed on any of the five newer antiepileptic agents. In a 1995 survey, 75% of similarly sampled neurologists agreed that no restrictions should be placed on the availability of FDA-approved medications. Nearly half (46%) of respondents favored a less effective test and would be willing to let patients die to ensure the offering of a more equitable alternative. CONCLUSIONS: Most neurologists recognize the need to ration health care, and although they think cost-effectiveness research is one method to achieve efficient distribution of resources, many think that considerable attention should also be given to equity.

Attitude of Health Personnel↗

PubMed2005

Comparing the supply of pediatric subspecialists and child neurologists.

OBJECTIVE: To examine physician workforce characteristics and workforce projections of one vulnerable pediatric subspecialty, child neurology, and compare this subspecialty with other pediatric subspecialties, general pediatrics, and adult neurology. STUDY DESIGN: National survey of child neurologists compared with other pediatric specialties in the Community Tracking Study Physician Survey (CTS) and the American Medical Association (AMA) Masterfile, and input-output workforce projections. RESULTS: Child neurologists are more likely than other specialists to report that the complexity or severity of patients' conditions at the time of referral is less than it should be and that the number of patients being referred to them has increased. Projections of the future workforce reveal that by 2022 the number of pediatric subspecialists and pediatricians will increase substantially, to almost 180% and 150% of the current workforce, respectively. Among child neurologists and adult neurologists, practicing physicians will be only 109% and 105% of the current workforce by 2022. CONCLUSIONS: Child neurologists are more likely to face future workforce shortages than other pediatric subspecialists. To reduce future shortages, recruitment efforts need to be concentrated on the at-risk subspecialties such as child neurology. In the short-term, addressing the high prevalence of inappropriate low-acuity referrals to child neurologists may ease the gap between supply and demand.

Career Choice↗

PubMed1999

The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists.

OBJECTIVE: To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. DESIGN: Mail survey. PARTICIPANTS: A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. MAIN OUTCOME MEASURES: Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. RESULTS: Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists (P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. CONCLUSIONS: The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.

Administration, Oral↗

PubMed2003

The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists.

PURPOSE: The diagnosis of psychogenic pseudoseizures has improved with the availability of video-electroencephalography (EEG) monitoring; however, the outcome of this difficult disorder has remained poor. In an attempt to elucidate factors contributing to this poor outcome, we hypothesized that neurologists and psychiatrists differ in their views of the diagnosis and management of psychogenic pseudoseizure patients. METHODS: The hypothesis was tested by using a brief anonymous questionnaire administered to neurologists and psychiatrists at continuing medical education (CME) conferences. RESULTS: We found that neurologists and psychiatrists differ significantly in their opinion as to the accuracy of the video-EEG procedure; psychiatrists view video-EEG as often inaccurate in the diagnosis of psychogenic pseudoseizures compared with neurologists (p < 0.001). Neurologists, more frequently than psychiatrists, thought that patients' own psychopathology rather than "doctors dropping the ball" was a predominant factor in contributing to therapeutic failure, but this difference between specialties did not reach statistical significance. CONCLUSIONS: Resolving the differences between neurologists and psychiatrists would be helpful in caring for psychogenic pseudoseizure patients. These results support the need to encourage psychiatrists to have an integral involvement in epilepsy centers and to improve the understanding of psychogenic pseudoseizures in both disciplines.

Attitude of Health Personnel↗

PubMed2002

Does the neurologist contribute to the care of patients with chronic back pain?

OBJECTIVE: To review the disposition and outcome of patients with back pain seen in a neurology clinic, and determine the value of the neurologist's input. BACKGROUND: Back pain is a common cause of referral to the neurology clinic, but it is not clear how much the neurologist contributes to the care of such patients. DESIGN/METHODS: We reviewed all new patients and new consultations seen for the following reasons: low back pain; 'sciatica'; 'back and leg pain', and 'spinal stenosis'. Patients were evaluated by a single attending neurologist at a general neurology clinic over a 2-year period (January 1997 through December 1998). RESULTS: During the 2-year period, there were 97 patients seen for the above reasons. The chief complaint was low back pain alone in 73, while it was combined with another symptom in 24 (leg pain in 18, buttock or hip pain in 6). Thirty-three patients were self-referred, 56 were referred by a healthcare professional, 3 were referred by attorneys, and the referral source was unclear in 5. Median age was (range 25-90) years. Forty-eight were males. Based on the clinical data (history and examination), clinical diagnoses were radiculopathy in 28, myelopathy in 2, uncomplicated spondylosis in 27, and other non-neurologic conditions in 45. Tests performed after the visit included X-rays in 31, CT in 1, MRI in 16, and EMG in 17. 'Final' diagnoses were radiculopathy in 29 patients, myelopathy in 2 (total neurologic n = 30), uncomplicated spondylosis in 27, and other non-neurologic diagnoses in 41 (total non-neurologic n = 67). The non-neurologic diagnoses included periarticular pain, bursitis, muscle strain, soft tissue injury, and vertebral compression fractures. Final dispositions in the non-neurologic group (n = 67) were: nonsteroidal anti-inflammatories (NSAIDs) in 34 patients; analgesics or muscle relaxants in 37; physical therapy for 19, and none (including rest and observation) for 22. Four patients were referred for epidural blocks. (Many patients had more than one final disposition.) Final dispositions in the neurologic group (n = 39) were: physical therapy (n = 9); NSAIDs (n = 12); analgesics or muscle relaxants (n = 12), and epidural blocks (n = 3). Three patients were referred for surgery, but only 1 had an operation. CONCLUSIONS: Of patients with back pain and related symptoms seen in a neurology clinic, about two thirds have non-neurologic conditions. These patients are usually treated symptomatically with medications, rest, and physical therapy, all of which could be managed by primary care physicians. In the neurologic group, the vast majority is treated in the same way as the non-neurologic group. When more specific measures are needed, such as surgery or pain management procedures (e.g., epidural blocks), then the patients could be evaluated directly by the proper specialist (pain management or spine surgery) rather than the neurologist. The neurologist's input does not significantly affect the diagnosis or the management, so that the neurologist appears to have no useful role in the management of such patients.

Adult↗

PubMed1996

What role do neurologists play in determining the costs and outcomes of stroke patients?

BACKGROUND AND PURPOSE: Despite growing concern over the large numbers of specialists in the United States, little information is available on how stroke treatment varies by the specialty of the attending physician. This study compares the costs and outcomes of acute stroke patients by physician specialty, especially between neurologists and other specialists. METHODS: We selected a random sample of Medicare patients aged 65 years and older admitted with cerebral infarction between January 1 and September 30, 1991, identified from the principal diagnosis on Medicare Provider Analysis and Review records. All Medicare claims for these patients were extracted from the date of admission through 90 days. The attending physician was identified as that physician billing for routine hospital visits during the first 7 days of the stay. RESULTS: Neurologists treating stroke patients were significantly more expensive than other physicians but obtained better outcomes. Ninety-day mortality rates for patients treated by neurologists were significantly lower than those for other specialists. These cost and outcome differences persisted even after adjustment for patient age, comorbidity, hospital teaching status, and other characteristics. Compared with other attending physicians, neurologists were significantly more likely to order diagnostic cerebrovascular tests (especially brain MRI scans), more likely to prescribe warfarin, and more likely to discharge patients to inpatient rehabilitation facilities. CONCLUSIONS: Systematic triaging to neurologists based on clinical characteristics unmeasured by administrative data might explain these observed differences between neurologists and other physicians. Alternatively, these specialists may have been better able to identify the mechanism of stroke, information that then affected the course of treatment. Given current pressures to substitute generalists for specialists, however, more research is needed on these stroke treatment differences.

Cerebrovascular Disorders↗

PubMed2003

Neurologists' assessment of their ability to provide high quality care.

OBJECTIVE: S: To assess levels of professional satisfaction and distress in a national sample of neurologists and to compare neurologists with other physicians. METHODS: The authors used data from the 1996 through 1997 and 1998 through 1999 Community Tracking Study Physician Survey and analyzed responses in the two time frames to measures of career satisfaction, physician autonomy and communication, and ability to obtain needed services for patients. RESULTS: Most physicians, including neurologists, are satisfied with careers in medicine. Neurologists feel they have more time to spend with patients than do other physicians but are more concerned than are other physicians about their ability to obtain needed services and to provide high-quality care for patients. One-third of all physicians feel that they cannot maintain the kind of continuing relationships with patients over time that are necessary for delivering high-quality care. CONCLUSION: The majority of physicians, including neurologists, are satisfied with medical practice today. Because some neurologists are experiencing significant professional distress, those factors that will enhance physician satisfaction, prevent burnout, and encourage high-quality interpersonal care need to be carefully examined and modified.

Attitude of Health Personnel↗

PubMed2003

The prevalence of migraine in neurologists.

To assess the prevalence of migraine among neurologists and neurologist headache specialists, the authors performed a survey of neurologists who attended a headache review course. The 1-year and lifetime prevalences of migraine in the 220 respondents were as follows: male neurologists, 34.7%, 46.6%; male headache specialists, 59.3%, 71.9%; female neurologists, 58.1%, 62.8%; and female headache specialists, 74.1%, 81.5%. Migraine is much more prevalent among neurologists than in the general population.

Adult↗