What would be my advice to a young neurologist, boldly birthing from the womb of the neurosciences ivory tower training ground to practice in the reality of medicine that is found in the district general hospital (DGH)? How could it be possible to survive without the skills of the ever available super-expert neuroradiologist and the safety net of the all embracing specialist centre?

The basic principles are of course simple common sense, and the specifics depend upon knowing and understanding radiologically useful neuroanatomy and the range of normal appearances. My remarks are directed primarily to the newly appointed consultant as she (or he) takes up a post which involves a mixed neurological practice of the hub and spoke variety or one based mainly in a district hospital. Established consultants will have either resolved the problems or alienated the local general department by insisting that all of her (or his) important examinations are referred up to the neuroradiology department for a “proper report”. This is not the way forward that I would recommend! Instead I suggest you follow my simple survival course.

FUND RADIOLOGICAL SUPPORT

At your consultant interview, and before you accept your consultant post, make sure that the employing authority has implemented the Royal College of Radiologists guideline for ensuring that extra funds are made available to support your imaging needs. This is equivalent to two sessions of radiology time per new consultant neurologist and one additional session for a replacement post. In this way it will be possible to benefit directly the local radiology service (make a friend for life) or to expand the specialist service in the neuro-centre so that a neuroradiologist can regularly visit the local hospital and forge links benefiting both services. This gives the local radiologist someone with whom they can discuss difficult neurological cases, and allows …