Madam, - As a consultant physician (recently retired) with the subspeciality of gastro-enterology, I must empathise with Mary Keane (January 11th).
The Association of General Physicians has repeatedly emphasised that the trained consultant generalist can deal locally with the vast majority of acute and chronic medical conditions - cardiological, neurological, respiratory, rheumatological, infectious, etc. Most such physicians have spent an additional year or two training in one of the above areas and may refer internally if a subspecialist works within their regional hospital or its catchment areas, or externally if specific expertise or facilities are required or requested.
Dr Tim Lynch, neurologist to the Mater Hospital, has repeatedly lamented, both in this newspaper and on radio, the paucity of public consultant neurologists in the Republic.
A regional hospital with access to CT and magnetic resonance scanning plus an experienced physician with neurological training can provide diagnostic and treatment expertise for the vast majority of neurological problems, including multiple sclerosis and Parkinson's disease. The difficult diagnostic or treatment case can be referred to specialist neurologist for advice, and returned to the base physician for ongoing care.
The majority of patients with Parkinson's disease (approximately 700 in the mid-west) may never see a neurologist and are managed by general practitioners, geriatricians with an interest in movement disorders or the local general physician. Each such patient requires highly individualist management, not just drug tailoring.- Yours, etc,
GERARD J BURKE, FRCP, Castleconnell, Co Limerick.