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The American sociologist Elliott Freidson and others have identified what is at the heart of professional work. Core attributes are that members have a specialised body of knowledge and that they provide a disinterested service to clients. The numbers entering the profession are controlled, often by examination of the knowledge acquired after a long apprenticeship. In addition, because the knowledge is specialised, the profession holds that only itself can be competent to judge the domain of its work and the extent to which good practice is being followed.1 Neurology, as a branch of the wider profession of medicine, fulfills all these characteristics, with a body of highly specialised knowledge, numbers tightly controlled by entry through training programmes and by examination, and a defined domain of work. The domain of work has been defined differently in different countries. In the United Kingdom, for example, psychiatric disease is not considered to lie within the province of neurology, although the two specialties are practised conjointly in other European countries such as Austria. Another restriction of the domain has been that stroke, one of the most frequent neurological disorders, was not really considered in the United Kingdom to be part of the main stream of neurological practice until about 20 years ago.
Society is willing to grant a profession power and privilege in exchange for the profession’s commitment to serve its needs, and society’s needs may change. Clinical neurology in developed countries moved many years ago away from its initial role as a largely diagnostic specialty, and has become increasingly concerned with the active treatment of many disorders, with the support and welfare of people with chronic neurological disorders, and with the reassurance and support of the many patients who consult neurologists with symptoms such as headaches and dizzy spells which are not clearly due to defined organic disease. Yet the question remains whether neurology is doing all it can to improve the health and wellbeing of the population it serves. Neurologists are also anxious about the potential impact of global economic change and health service reform on teaching, practice, and research.2 3
These concerns of neurologists in the United Kingdom and in other countries have been matched by those of the World Health Organisation (WHO), which has launched a global initiative aimed at increasing public and professional awareness of neurological disorders. As Dr Aleksander Janca and his colleagues from WHO describe in the first article, WHO has encouraged a series of symposia in different countries on public health aspects of neurology, considering the epidemiology of neurological disorders, the needs of the population, the organisation and cost of services, measures aimed at reducing the burden on the family and the community, and the planning of programmes and policies at a governmental level.
The contents of this supplement represent the work done in the United Kingdom in this area, at the suggestion of WHO. A workshop was held on 18 July 1996 at the Royal College of Physicians, organised by the Research Unit of the College and the Association of British Neurologists (ABN). Background papers were prepared in the following principal areas: the impact of neurological illness and disability on the health of the population; the possibilities for the primary prevention of neurological illness; the distribution of neurological services; and the likely priorities for neurological research and development. The papers were presented at this workshop, and then discussed by neurologists from the National Health Service (NHS) and Universities, public health physicians, and representatives from general practice, patient groups, and the Department of Health. In the last section, Professor John Newsom-Davis of the University of Oxford and myself attempt to draw conclusions from the workshop day.
I thought that this supplement should not appear without brief summaries of the position of undergraduate medical education in neurology, of postgraduate specialised training in neurology (after general professional training), and of the views of the ABN on the numbers of clinical neurologists and trainees required in the United Kingdom. I am grateful therefore for permission from the journalMedical Education to reprint the statement on medical education in neurology prepared by the World Federation of Neurology Research Group on Medical Education, the Royal College of Physicians of London, and the World Federation for Medical Education, and to the Joint Committee on Higher Medical Training for permission to reproduce the section on neurology from its handbook. I am also grateful to Dr David Stevens and the ABN for permission to reproduce their document on the numbers of clinical neurologists and trainees required to provide a good service.
A review organised by the World Health Organization, the Association of British Neurologists, and the Royal College of Physicians (Research Unit)
Supplement editors: Anthony Hopkins and David Perkin
The papers for this supplement were organised by Dr Anthony Hopkins, who died earlier this year. The final version of the supplement is slightly different from the earlier version, and further amendments were made by Dr David Perkin. It is hoped that the final format of the supplement would have been approved by Dr Hopkins.
This supplement was made possible by educational grants from the British Medical Association, the Royal College of Physicians, the Association of British Neurologists, Glaxo Wellcome UK, Roche Products Ltd, and Teva Pharmaceuticals Ltd.