As the health delivery system progresses to ever more expensive high technology, testing the discipline of neurology faces the problem of its justification to other specialties and its cost-effectiveness. In the area of diagnosis and management of multiple sclerosis, this becomes more apparent. The diagnosis and outcome assessment are becoming more and more confined to neuroimaging (magnetic resonance imaging), electrodiagnostic testing (evoked potentials), spinal fluid examination (cell counts, oligoclonal bands, and myelin basic proteins), neuropsychologic testing (tests too numerous to be listed), and disability determination by rehabilitation professionals. Will it be some day that the patient notices blurred vision in one eye, goes to the eye specialist who then refers the patient for a magnetic resonance imaging, and does not pass the neurologist who does not collect $200? It may occur that, with the development of new effective cures, the neurologist will be left out of the loop.
Scheinberg L. High Tech, Low Tech in the Era of Health Reforms. Arch Neurol. 1995;52(3):231–232. doi:https://doi.org/10.1001/archneur.1995.00540270017006
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