Feature Christmas 2009: Diagnosis

House calls: The case of the entertaining case

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5256 (Published 16 December 2009) Cite this as: BMJ 2009;339:b5256
  1. Rhys H Thomas, specialty registrar and clinical research fellow12,
  2. Naomi J P Thomas, specialty registrar3
  1. 1Wales Epilepsy Unit, University of Wales, Heath Park, Cardiff CF14 4XW
  2. 2Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Swansea SA2 8PP
  3. 3Prince Charles Hospital, Merthyr Tydfil
  1. Correspondence to: R H Thomas rhys-thomas{at}doctors.org.uk

    Intrigued by a common assumption that neurological cases are over-represented in published case reports, Rhys Thomas and Naomi Thomas investigate whether this is true and explore possible reasons for it


    Neurophobia—the fear of neurology1—is well described in medical students and is postulated as the reason for an apparent bias favouring neurology in case studies. Neurological cases represent more than a quarter of all Lancet case reports: 29% of 523 cases during 1996-20022 and 26% of 360 cases during 2003-8.3 Coles et al attributed this to “the trepidation and interest that neurological syndromes generate among physicians.”2 They considered this stigmatisation of a core medical specialty to represent our continued inability to demystify the subject.

    However, the literature does not tell us whether neurological cases are genuinely over-represented or merely appropriately common. We set out to determine this by comparing the pattern of cases from a UK publisher (BMJ Case Reports) with the UK burden of disability. We also hypothesise that a more eloquent explanation for …

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