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The seven authors of this text are to be congratulated on their innovative approach and the freshness they bring to the evaluation of the common neurological problems encountered in primary care. This text and the two accompanying CD ROMs represent a cooperative venture between the British Brain and Spine Foundation, the Royal College of General Practitioners and the University of Bath. The text addresses the commonly encountered problems of headache, sensory disturbance, cerebrovascular disease, dementia, confusion, movement disorders, fits and faints, and back, leg, and arm pain. The approach is a simple one—namely, a definition of the condition or conditions, who gets it? What causes it? How does it present? What is the differential diagnosis? How is it investigated and managed? This pragmatic approach pays special attention to the prevalence of each disorder in the community and contains “red flags” where there is diagnostic doubt and uncertainty. The two accompanying CD ROMs outline learning outcomes, case histories, self assessment questionnaires, and case pathways with respect to investigation, management, and prognosis. Each such case is linked with the text prividing assignments in clinical audit, comment, documentation of data, and “setting standards”. Incorporated in all of this are useful components such as data collection sheets for specific symptoms and summary sheets to aid and improve documentation.
I found this an interesting book and enjoyed finding my way around the CDs, which were easy to use. I would imagine that this would be a valuable aid for the busy general practitioner and should help set standards in primary care that would aid patients and ensure thorough evaluation before referral. The only thing missing was guidance demarcating between evaluation in the primary care setting from the need to refer on for a specialist opinion. All of us occasionally think, under moments of work overload, that our colleagues in primary care could be a little more circumspect in whom they refer (although the truth of the matter is that most referrals are thoughtful and necessary). A text such as this with no obvious competitor, is long overdue, written by neurologists who, along with their general practitioner colleague, have adopted a common sense approach to their task. I would strongly recommend this book with its accompanying CD ROMs to my general practitioner colleagues in the belief that it would serve to demystify our specialty. Perhaps in future editions the authors might consider incorporating referral guidelines that would be a useful supplement to a text that, for example, takes general practitioners through from the suspicion of brain tumour to the process of biopsy and subsequent radiotherapy. While such data informs and allows the practitioner to explain to his or her patient what they might expect to encounter in the process of investigation and treatment, it does not clearly define who does what and when.
In conclusion, I recommend this innovative text, which, alough directed primarily at our general practitioner colleagues, contains something for all on the simple approaches of evaluation, the importance of documentation, and the value of using an interactive CD ROM as an educational tool. I think that this text goes a long way not just to educate and entertain, but also remove from primary care, the notion that neurology is a difficult and uncertain area.
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