Relevant Neurologic Problems in Primary Care

From WiserWiki

[edit] Relevant Neurologic Problems in Primary Care

T. Jock Murray

Neurologic problems are frequent in daily primary care practice. About 10% of patients consulting a primary care physician have a neurologic symptom and 1% to 2% of such complaints result in a definite neurologic diagnosis. Most patients can be effectively managed by the general physician; others can be managed with a single neurologic consultation for advice on diagnosis or management, and only a few require ongoing management by a neurologic consultant. This presupposes that the general physician has knowledge of some basic concepts about the nervous system, has an effective and efficient neurologic examination that is used routinely, and has an understanding of the common, emergent, and treatable neurologic conditions. The following chapters focus on these conditions.

Most primary care physicians manage neurologic patients well, but studies have shown that they may lack confidence in the neurologic examination, the interpretation of the results of the examination, or determinations of which investigations are necessary.^[1][2] In these studies, when the physician was not confident of the assessment, the outcome was not usually referral to a neurologist but a tendency to dismiss the patient as quickly as possible. The physicians in such instances indicated they did not like diagnosing and treating neurologic conditions. Developing competence in the assessment and management of common and treatable neurologic conditions leads to a positive attitude about a very interesting and rewarding aspect of primary care medicine.^[3][4]

The primary care physician should have competence in the following four areas:

• Background concepts and knowledge of the nervous system that allow understanding and localization of neurologic disorders
  
• Appropriate attitudes toward people with neurologic diseases
  
• A neurologic examination that is brief and efficient
  
• Conditions that are common, that require emergency management, and that are treatable^[5]
  The important conditions in which the primary care physician should have confidence and ability to assess and manage, even if the management is to recognize when referral is required, are listed in Box 156-1.

The array of neurologic problems seen in the primary care physician's office can be tabulated according to an emphasis score, with varying emphasis scored on the basis of frequency of the problem, potential seriousness, and the effect of intervention on the outcome (Table 156-1).

Table 156-1 Emphasis Score for Neurological Conditions in Primary Care Practice

✢A score of 1 to 5 is given for each factor. The emphasis score is determined by multiplying the three factors:frequency × seriousness × effect of intervention.

[edit] REFERENCES