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Reply from the Authors: We appreciate the opportunity to address the responses to our article proposing a "principal'' or "primary'' care plan for patients with neurologic diseases. Although we will comment on the main issues raised by each correspondent, we will do so in the spirit in which we offered our proposal. We leave to the journal's readership to judge the motives that brought us to propose that neurologists provide "principal'' or "primary'' care for patients with primary neurologic diseases. [1]
The comments of Drs. Fielder, Jaffe, and Menken can be grouped into three areas: the competence of neurologists to provide primary care, the education of generalists in neurology, and the projected need for neurologists in a changing health care delivery system. Drs. Fielder and Jaffe question whether neurologists have the training to function as primary care physicians. We would suggest that well-trained neurologists are competent to provide primary care for patients with diseases of the nervous system. Neurologists are better equipped than generalists also to understand and care for the complications of neurologic disease. Fielder and Jaffe suggest they would not wish to have their non-neurologic problems managed by a neurologist. Jaffe cites the example of stroke in the context of diabetes and hypertension. As all neurologists are aware, management of blood pressure and serum glucose, inter alia, during the acute stages of stroke is essential for the best outcome. Do we stop managing these problems when patients enter the chronic stage of their neurologic disease? We think not.
Dr. Fielder's example allows us to address a second …
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