Only a neurologist with a petrified diaphragm could fail to enjoy the description of the neurologist's bag. The article also highlights certain salient aspects of the delivery of medical care. Neurologists in the United Kingdom spend most time in practice, evaluating and managing patients, doing so called direct patient care. By contrast, in the United States, neurology has become a high tech specialty, and many younger neurologists and their patients would consider the bag of bedside tools somewhat passé. With neuroimaging (computed tomography and magnetic resonance imaging) readily available and most neurologists trained to perform a myriad of investigations such as electromyography, duplex ultrasonography, and electroencephalography, the practice of neurology on my side of the Atlantic is improbable during a power blackout.

Zoe Ash reminds us that the role of a specialist is defined in part by social and cultural factors, in addition to the burden of illness in the population. For example, most of my patients expect to have their care orchestrated by a specialist, and insist that a magnetic resonance imaging scan be performed for chronic headaches or dizziness, no matter how much reassurance the bag and I provide. As a result, there are roughly 10 neurologists in the United States per head of population for each neurologist in the United Kingdom, and my hunch is that the ratio is somewhat similar among nephrologists, hand surgeons, and other groups of specialists. Such a wide variance in the "density" of specialists in relation to a burden of illness that is more or less the same in both populations, inevitably raises the nagging question; is there a better way?