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To: Journal of NEUROL NEUROSURG PSYCHIATRY Letters

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Editorial: R J Davenport Why can’t I make neurological diagnoses anymore? PRACTICAL NEUROLOGY 2008; 8: 74-76 [Full text] [PDF]

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The superspecialization of neurology

Nitin K Sethi   (24 April 2008)

The superspecialization of neurology 24 April 2008
Nitin K Sethi, MD Comprehensive Epilepsy Center, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.) Send letter to journal: Re: The superspecialization of neurology sethinitinmd{at}hotmail.com Nitin K Sethi	Dear Editor, I read with keen interest Dr. Davenport’s editorial” why can’t I make a neurological diagnoses anymore?” 1. I am currently in my second year of fellowship training in clinical neurophysiology in the USA and even though I am heading down the path of superspecialization or rather subspecialization in neurology, as Dr. Davenport points out, I could not agree more with his comments. Here in the USA, residency in neurology is for 3 years after one year of compulsory internship in general medicine. Fellowship training ranges in duration anywhere from one to three years with an average of one year. It surprises me that now when I am applying for a job, I am more marketable as an epileptologist rather than as a general neurologist or rather generalist as Dr. Davenport refers to himself. Surely at least at this juncture by the virtue of the time spent in training, I am a more competent general neurologist rather than an epileptologist. Maybe as time goes by and if I restrict myself to seeing only epilepsy patients, I would become a competent epileptologist too. My only fear is that, then I would not know what to do if a patient with migraine walked through my office doors. I would surely need the expertise of a generalist like Dr. Davenport. Or maybe I would refer the patient to a headache specialist. Neither of the extremes seem sensible to me and I agree with Dr. Davenport that the answer probably lies in a system that places emphasis on general neurologists, some with special interests in certain areas like epilepsy. Nitin K.Sethi The author reports no competing interests. References 1. Davenport RJ. Why can't I make neurological diagnoses anymore? Pract Neurol 2008;8:74-76.