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October 1989, Vol 46, No. 10 >
Article | October 1989

Differences in Strategies for the Diagnosis and Treatment of Neurologic Disease Among British and American Neurologists

Anthony Hopkins, MD; Matthew Menken, MD; Gordon H. DeFriese, PhD; Robert G. Feldman, MD
[+] Author Affiliations

Accepted for publication February 15, 1989.

Reprints not available.


Arch Neurol. 1989;46(10):1142-1148. doi:10.1001/archneur.1989.00520460138029
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References
Comments

There is, at present, considerable interest in the differences among medical specialties in the way in which certain types of medical care are provided. Much of the impetus for the study of interspecialty comparative health services research arises from the effort to measure the differences between specialist and generalist physicians in the nature, volume, and costs of care for much the same types of clinical conditions. In the United States, the study of interspecialty differences in medical care is important with respect to the national effort to assure adequate access to primary health care services, on the one hand, and the effort partially to reduce health sector costs through formal mechanisms of control that limit patient access to specialist services. A variety of systems of control have been introduced that make access to specialist services possible only with the concurrence of a primary care physician (eg, the so-called gatekeeper

REFERENCES

1 +
Kurtzke JF, Bennett DR, Berg BO, Beringer BD, Goldstein M, Vates TS.  Neurologists in the United States—past, present, and future . Neurology . 1986;;36:1576-1582.
2 +
 Medical and dental staffing prospects in the NHS in England and Wales in 1986 . Health Trends . 1987;;19:1-8.
3 +
Central Statistical Office Tables. London, England: Her Majesty's Stationary Office; 1986.
4 +
Mendenhall RC. Neurology Practice Study Report . Los Angeles, Calif: University of Southern California School of Medicine; 1979;.
5 +
Mendenhall RC, Girard RA, Abrahamson S.  A national study of medical and surgical specialties, I: background, purpose and methodology . JAMA . 1978;;240:848-852.
6 +
Perkin GD.  Necessity for inpatient services in neurological practice . J R Soc Med . 1983;;76:920-923.
7 +
Fitzpatrick R, Hopkins A.  Referrals to neurologists for headaches not due to structural disease . J Neurol Neurosurg Psychiatry . 1981;;44:1061-1067.
8 +
Till JS, Toole JF, Howard VJ.  Physicians' attitudes: management of carotid artery plaques, murmurs, and transient ischemic attacks . Arch Neurol . 1985;;42:1198-1201.
9 +
Toole JF, Howard VJ.  Physician attitudes: management of asymptomatic carotid artery murmur and transient ischemic attacks . Arch Neurol . 1981;;38:443-446.
10 +
Heverly MA, Fitt DX, Newman FL.  Constructing case vignettes for evaluating clinical judgment: an empirical model . Evalu Prog Plan . 1984;;7:45-55.
11 +
Pearlman RA, Inui TS, Carter WB.  Variability in bioethical decision making . Ann Intern Med . 1982;;97:420-425.
12 +
Rothert ML, Rovner DR, Elstein AS, Holzman GB, Holmes MM, Ravitch MM.  Differences in medical referral decisions for obesity among family practitioners, general internists, and gynecologists . Med Care . 1984;;22:42-55.
13 +
Goran MJ, Williamson JW, Gonnella JS.  The validity of patient management problems . Med Educ . 1973;;48:171-177.
14 +
Menken M, Hopkins A, DeFriese G.  Norms of care in British and American neurological practice . Arch Neurol . 1988;;45:94-98.
15 +
Wolf PA, Kannel WB, Cupples LA, d'Agostino RD.  Update on epidemiology of stroke . In: Rose FC, ed. Royal Society of Medicine International Congress and Symposium Series . London, England: Royal Society of Medicine; 1986;;99:3-9.
16 +
Bonita R, Scragg R, Stewart A, Jackson R, Beaglehole R.  Cigarette smoking and risk of premature stroke in men and women . Br Med J . 1986;;293:6-8.
17 +
Harrison MJG.  The investigation of strokes . In: Russell RWR, ed. Vascular Disease of the Central Nervous System . 2nd ed. New York, NY: Churchill Livingstone Inc; 1983;:154-168.
18 +
Gebarski SS, Gabrielsen TO, Gilman S, Knake JE, Latack JT, Aisen AM.  The initial diagnosis of multiple sclerosis: clinical impact of magnetic resonance imaging . Ann Neurol . 1985;;17:469-474.
19 +
Henson RA, Urich H. Cancer and the nervous system: the neurological manifestations of systemic malignant disease . New York, NY: Blackwell; 1982;.
20 +
Chiofalo N, Fuentes A, Galvez S.  Serial EEG findings in 27 cases of Creutzfeldt-Jakob disease . Arch Neurol 1980;;37:143-145.
21 +
Hachinski VC, Iliff LD, Zilkha E, et al.  Cerebral blood flow in dementia . Arch Neurol . 1975;;32:632-637.
22 +
Dyken ML.  Carotid endarterectomy studies: a glimmering of science . Stroke . 1986;;17:355-358.
23 +
Wennberg JE.  The paradox of appropriate care . JAMA . 1987;;258:2568-2569.
24 +
Wennberg JE, Freeman JL, Culp WJ.  Are hospital services rationed in New Haven or overutilised in Boston? Lancet . 1987;;1:1185-1189.
25 +
Office of the Actuary, Division of National Cost Estimates. Washington, DC: Health Care Financing Administration; June 1987.
26 +
Aaron HJ, Schwartz WB. The Painful Prescription: Rationing Hospital Care . Washington, DC: Brookings Institution; 1984;.
27 +
Miller FH, Miller GAH.  The painful prescription: a procrustean perspective? N Engl J Med . 1986;;314:1383-1385.
28 +
Daniels N. Just Health Care . New York, NY: Cambridge University Press; 1985;.
29 +
Daniels N.  Why saying no to patients in the United States is so hard . N Engl J Med . 1986;;314:1380-1383.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kurtzke JF, Bennett DR, Berg BO, Beringer BD, Goldstein M, Vates TS.  Neurologists in the United States—past, present, and future . Neurology . 1986;;36:1576-1582.
2 +
 Medical and dental staffing prospects in the NHS in England and Wales in 1986 . Health Trends . 1987;;19:1-8.
3 +
Central Statistical Office Tables. London, England: Her Majesty's Stationary Office; 1986.
4 +
Mendenhall RC. Neurology Practice Study Report . Los Angeles, Calif: University of Southern California School of Medicine; 1979;.
5 +
Mendenhall RC, Girard RA, Abrahamson S.  A national study of medical and surgical specialties, I: background, purpose and methodology . JAMA . 1978;;240:848-852.
6 +
Perkin GD.  Necessity for inpatient services in neurological practice . J R Soc Med . 1983;;76:920-923.
7 +
Fitzpatrick R, Hopkins A.  Referrals to neurologists for headaches not due to structural disease . J Neurol Neurosurg Psychiatry . 1981;;44:1061-1067.
8 +
Till JS, Toole JF, Howard VJ.  Physicians' attitudes: management of carotid artery plaques, murmurs, and transient ischemic attacks . Arch Neurol . 1985;;42:1198-1201.
9 +
Toole JF, Howard VJ.  Physician attitudes: management of asymptomatic carotid artery murmur and transient ischemic attacks . Arch Neurol . 1981;;38:443-446.
10 +
Heverly MA, Fitt DX, Newman FL.  Constructing case vignettes for evaluating clinical judgment: an empirical model . Evalu Prog Plan . 1984;;7:45-55.
11 +
Pearlman RA, Inui TS, Carter WB.  Variability in bioethical decision making . Ann Intern Med . 1982;;97:420-425.
12 +
Rothert ML, Rovner DR, Elstein AS, Holzman GB, Holmes MM, Ravitch MM.  Differences in medical referral decisions for obesity among family practitioners, general internists, and gynecologists . Med Care . 1984;;22:42-55.
13 +
Goran MJ, Williamson JW, Gonnella JS.  The validity of patient management problems . Med Educ . 1973;;48:171-177.
14 +
Menken M, Hopkins A, DeFriese G.  Norms of care in British and American neurological practice . Arch Neurol . 1988;;45:94-98.
15 +
Wolf PA, Kannel WB, Cupples LA, d'Agostino RD.  Update on epidemiology of stroke . In: Rose FC, ed. Royal Society of Medicine International Congress and Symposium Series . London, England: Royal Society of Medicine; 1986;;99:3-9.
16 +
Bonita R, Scragg R, Stewart A, Jackson R, Beaglehole R.  Cigarette smoking and risk of premature stroke in men and women . Br Med J . 1986;;293:6-8.
17 +
Harrison MJG.  The investigation of strokes . In: Russell RWR, ed. Vascular Disease of the Central Nervous System . 2nd ed. New York, NY: Churchill Livingstone Inc; 1983;:154-168.
18 +
Gebarski SS, Gabrielsen TO, Gilman S, Knake JE, Latack JT, Aisen AM.  The initial diagnosis of multiple sclerosis: clinical impact of magnetic resonance imaging . Ann Neurol . 1985;;17:469-474.
19 +
Henson RA, Urich H. Cancer and the nervous system: the neurological manifestations of systemic malignant disease . New York, NY: Blackwell; 1982;.
20 +
Chiofalo N, Fuentes A, Galvez S.  Serial EEG findings in 27 cases of Creutzfeldt-Jakob disease . Arch Neurol 1980;;37:143-145.
21 +
Hachinski VC, Iliff LD, Zilkha E, et al.  Cerebral blood flow in dementia . Arch Neurol . 1975;;32:632-637.
22 +
Dyken ML.  Carotid endarterectomy studies: a glimmering of science . Stroke . 1986;;17:355-358.
23 +
Wennberg JE.  The paradox of appropriate care . JAMA . 1987;;258:2568-2569.
24 +
Wennberg JE, Freeman JL, Culp WJ.  Are hospital services rationed in New Haven or overutilised in Boston? Lancet . 1987;;1:1185-1189.
25 +
Office of the Actuary, Division of National Cost Estimates. Washington, DC: Health Care Financing Administration; June 1987.
26 +
Aaron HJ, Schwartz WB. The Painful Prescription: Rationing Hospital Care . Washington, DC: Brookings Institution; 1984;.
27 +
Miller FH, Miller GAH.  The painful prescription: a procrustean perspective? N Engl J Med . 1986;;314:1383-1385.
28 +
Daniels N. Just Health Care . New York, NY: Cambridge University Press; 1985;.
29 +
Daniels N.  Why saying no to patients in the United States is so hard . N Engl J Med . 1986;;314:1380-1383.

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