A generation ago, when a specialist was faced with the diagnostic dilemma, he would call the chairman of the department at the medical school; it was there that wisdom and experience resided. Such is no longer the case. In medical schools, professors rise to the top by acquiring special skills in a very small area of clinical investigation. Diagnostic acumen, however, is not based on the cultivation of narrowly specialized interests, but broad-based experience.
More and more of the patients referred to the neuropsychiatry clinics are referred by doctors confronted with a diagnostic dilemma, and nowhere else to go for the right answer. We are used to dealing with such problems, and the most challenging cases are usually the subject of clinical conferences. Many of the conditions in neuropsychiatry are unusual and rarely met with in the ordinary practice of psychiatry and neurology. Because we have been working with neuropsychiatric patients for so many years, we have had extensive experience with rare and unusual syndromes or with unusual clinical presentations of common conditions.