Norms of care in British and American neurologic practice

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.