Norms of care in British and American neurologic practice
M. Menken, A. Hopkins and G. H. DeFriese
Department of Neurology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick.
At a Consensus Development Conference on the Scope of Neurological Practice
in the United Kingdom, 26 British specialists in the field of neurology
constructed norms of care for patients with 11 neurologic disorders. For
each disorder, these specialists specified the percentage of all patients
who should see a physician, as well as the percentage who should see a
consultant neurologist, the appropriate duration of the initial patient
encounter, and the appropriate frequency of follow-up visits per annum.
When compared with American estimates used in health manpower planning,
British neurologists generally make a far greater allowance for patient
self-care, as well as care by nonphysician health care providers, allow
less time for patient encounters, and see a need for follow-up care less
frequently. These marked differences in the perceptions of specialists of a
normative character may determine, in part, the different "practice styles"
of physicians in different regions that cannot be explained in economic
terms. Results suggest that the practice style concept should be broadened
to include the use of health personnel of many types, the scope of
specialty medicine, and the role definition of primary care.
