Confidence level of general physicians in treating neurosurgical conditions: Findings from the Philippines

Introduction: The lack of neurosurgeons in our country leaves the burden of providing neurosurgical care to general physicians. We sought to assess the attitudes and confidence level of general physicians in treating neurosurgical disease.

Methods: A cross-sectional study design was used. An anonymous questionnaire was distributed among online groups of general physicians to recruit subjects and assess their attitudes and confidence level in managing neurosurgical conditions.

Results: A total of 186 general physicians completed the questionnaire. The mean age of the participants was 29.5 years, and there were more women (63%) than men. They graduated from medical school at a mean of 3.5 years ago, and have worked as a general physician for a mean of 2 years (range 0-13). Most (62%) reported that they had dedicated neurosurgery subjects during medical school, but only half (52%) had a neurosurgery rotation during internship. Approximately half (52%) of the general physicians worked in rural areas. Majority (71%) worked in 1-2 hospitals only. An overwhelming majority (67%) of hospitals where they worked did not have any neurosurgeon available; only 24% had an in-house neurosurgeon while 9% had neurosurgeons on call for referrals. Majority (71.5%) used websites as educational material. The most common neurosurgical conditions encountered were cerebrovascular diseases and traumatic brain injury. The respondents were somewhat confident in handling vascular and trauma cases, but not confident with congenital and spine. Overall, the general physicians surveyed were not confident in treating neurosurgery patients. Confidence level was significantly associated with older age, male gender, increased work experience, and neurosurgeon availability.

Conclusion : Action should be taken to improve the ability and confidence of general physicians in providing care for neurosurgical patients, via further education and exposure. Standard referral systems should also be organized in areas where there is a paucity of neurosurgical expertise.