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Should stroke medicine be a separate subspecialty?

BMJ 1998; 316 doi: (Published 14 February 1998) Cite this as: BMJ 1998;316:628

Should stroke medicine be a separate subspecialty?

  1. R Langton Hewer, Professor
  1. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. Royal Perth Hospital, Perth, Australia
  3. St Charles's Hospital, London W10 6DZ

    EDITOR—Bath et al have argued cogently for a subspecialty of stroke medicine.1 I venture to suggest a modification of their proposal. They state correctly that during the past 20 years knowledge of stroke (its course, pathophysiology, effective interventions, etc) has increased greatly. The knowledge base seems likely to continue to grow in the next few years. It is, however, much less certain that there will be an equivalent widespread improvement in service provision. Something needs to be done about this. The creation of a stroke specialty is one option, and the suggestion needs careful consideration. Three points are perhaps worth making.

    Firstly, disease specific specialties within medicine have not found favour in Britain, the preference being for generalism with an interest in a particular system. Secondly, the creation of a subspecialty, as suggested, would have appreciable implications well outside the area of stroke (for example, on training requirements and deployment of hospital beds). Thirdly, the three phases of stroke—prevention, acute care, and rehabilitation—involve different skills. For example, few consultants are fully knowledgeable about the pathophysiology of acute cerebral ischaemia and about rehabilitation.

    An opportunity now exists to refashion some parts of medical practice, with an increased emphasis on clinical problems rather than diseases. Such an approach would involve identifying what …

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