Dr Geoff Cloud, consultant stroke physician at St George's Hospital, London, shares why he chose stroke as a career, what he enjoys about the specialty, and what are the most important changes and challenges in the specialty at the moment.
Stroke medicine welcomes physicians from different parent training paths and gives the opportunity to work with a diverse team of professionals across many disciplines. It is an intellectually demanding and fascinating specialty which requires a breadth of clinical knowledge and excellent communication skills.
Stroke physicians enjoy the oversight of the entire patient journey. Patients present with a broad range of clinical symptoms from unilateral weakness or speech disorder to a constellation of neurological symptoms and signs that may be challenging to interpret. The stroke physician needs multiple skills to process information quickly and effectively; asking key questions, interpreting often complex clinical signs, understanding the intricate interaction of different disease processes and assessing what the brain scan reveals. There is pressure to act quickly to prevent neuronal loss.
The outcomes can be highly rewarding; whether it is a patient whose disability is reduced or prevented by thrombolysis, one reassured by our decisions and explanations, or a patient guided through their recovery who returns to greet us in clinic, having previously been unable to speak. Stroke medicine offers the privilege of meeting a patient when they are struck by life-changing illness and being able to guide them through their whole journey.
Ian McDonald held the officer post of Harveian Librarian at the RCP from 1997 to 2004. A minor stroke in 2004 removed, for a while, his ability to read a score and play the piano. As a neurologist he wrote his own case study, Musical alexia with recovery: a personal account, published in Brain.
RCP fellow William Cole (1635–1716) was described as being ‘learned without ostentation, and polite without affectation’. His book, A physico-medical essay concerning the late frequency of apoplexies : together with a general method of their prevention, and cure was published in 1689, and is the oldest book in English in the RCP library devoted to the topic of stroke.
Sir William Henry Broadbent (1835–1907) was a leading British authority in both cardiology as well as neurology. In 1876 he was the first to describe a type of stroke caused by a cerebral haemorrhage into the ventricular system, that was later to be named Broadbent apoplexy. Several of his works are held in the RCP library along with portrait prints in the museum collection.
Richard Stevens (1912–1998) distinguished himself in the army, in general practice and in geriatric medicine, but his greatest achievements came after his retirement. At the end of his career, after his wife suffered a stroke, he became seized with the need for better care of stroke patients and resolved to devote the rest of his life to this end. Stevens was one of the first to realise the importance of accurately recording the incidence of stroke in a defined community.
Reporting in 1982 on a stroke registry which he set up in south east Kent he showed that only 30% survived a year. He also set up a research project in Dover and demonstrated in a controlled trial the value of a specialist stroke unit. These pioneer studies caused him to be recognised as a leading authority.
Stevens led the way in helping stroke patients and their families through stroke clubs and support workers and stroke coordinators. He promoted public education through information centres and above all through the promotion of research. It was largely due to his efforts that the first chair of stroke medicine was set up with funding from the Association at Nottingham University in 1992.
In recent decades the RCP has participated in several intercollegiate working parties to produce clinical guidelines in the area of stroke. These include the most recent National clinical guidelines for stroke in 2012, Stroke in childhood: clinical guidelines for diagnosis, management and rehabilitation, in 2004, and The national sentinel audit for stroke: a tool for raising standards from 1999. Copies of these and all RCP records are available in the library.