When Lawrence D. first started having sporadic episodes of déjà vu followed by hours of mild confusion, he became concerned and informed his family physician. He was told that if it did not occur in his office, he could not offer any insight. Several months later, Lawrence had a generalized tonic clonic seizure and was admitted to the hospital where he was seen by a neurologist and diagnosed with epilepsy.
“What do you mean, you can’t get a head CT tonight? This man is having a stroke!”
My frustration must have seemed utterly naïve to the rural emergency physician on the other end of the line. It was 0100 on a Saturday, and I was taking a telephone consultation at a hospital in northern England, about a patient who appeared to have developed classic symptoms of a lateral medullary stroke. In the heat of the moment, I had forgotten that I was no longer in my familiar comfort zones of the John Radcliffe Hospital (Oxford) or the Foothills Medical Centre (Calgary, Canada), where I could always count on an emergent CT scan for an acute stroke. Fortunately for the patient in question, we could quickly arrange for the patient to be transferred to my centre for urgent neuroimaging and stroke-unit admission.
In its 2001 landmark report, the Institute of Medicine wrote, “[Between] the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”1 The purpose of “Innovations in Care Delivery” is to help bridge that chasm for those affected by neurological conditions.