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.
Introduction to stroke medicine
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.
Training and working in stroke medicine
- Stroke medicine is a subspecialty. For information on the training pathway, see the Joint Royal Colleges of Physicians Training Board.
- Learn more about the recruitment and interview process through ST3 recruitment.
Stroke resources
RCP resources
- SSNAP (Sentinel Stroke National Audit Programme)
- Consultant physicians working with patients – stroke medicine chapter
- Census of consultant physicians in the UK 2012 – specialty specific report: stroke
- Royal College of Physicians. National clinical guideline for stroke, fourth edition. London: RCP, 2012 (working party report)
- Royal College of Physicians. Care after stroke or transient ischaemic attack. Information for patients and their carers. London: RCP, 2012
- Royal College of Physicians. Diagnosis and initial management of transient ischaemic attack. London: RCP, 2010.
- National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008.
- Clinical Medicine articles:
- Dewan B, Skrypak M, Moore J, Wainscoat R. A service evaluation of the feasibility of a community-based consultant and stroke navigator review of health and social care needs in stroke survivors 6 weeks after hospital discharge. Clin Med 2014;14:134-140.
- Hurford R, Tyrrell PJ. Stroke thrombolysis: where are we and where are we going? Clin Med 2013;13:s20-s23.
- Moynihan B, Chowdhury R, Pereira A. FAST positive does not always mean stroke. Clin Med 2010;10:194-195.
- Akinsanya J, Diggory P, Heitz E, Jones V. Assessing capacity and obtaining consent for thrombolysis for acute stroke. Clin Med 2009;9:239-241.
- Barker D, Cassidy T. Effects of diagnostic uncertainty and misclassification on hospital performance indicators for acute stroke care. Clin Med 2014;14:597-600.
- Shaik S, Ul-Haq MA, Emsley HCA. Myasthenia gravis as a ‘stroke mimic’ – it’s all in the history. Clin Med 2014;14:640-642.
- RCP Library Resources
- ebooks and ejournals available online to members [email library@rcplondon.ac.uk for a password] include:
- Cerebrovascular diseases (1997 to present) (Embargo: 1 year)
- Pendlebury St, Schulz U, Malhotra A, Rothwell P. Oxford case histories in TIA and stoke. Oxford : Oxford University Press, 2012
- Casper ST, Jacyna LS. The neurological patient in history. Rochester, New York : University of Rochester Press, 2012
- Pendlebury St, Schulz U, Malhotra A, Rothwell P. Oxford case histories in TIA and stoke. Oxford : Oxford University Press, 2012 [Also available in print]
- Casper ST, Jacyna LS. The neurological patient in history. Rochester, New York : University of Rochester Press, 2012 [Also available in print]
- Books available by postal loan from the library include:
- Hennerici MG, Kern R, Caplan LR, Szabo E (eds). More case studies in stroke : common and uncommon presentations. Cambridge : Cambridge University Press, 2014
- Torbey MT, Selim MH. The stroke book. Cambridge : Cambridge University Press, 2013
- Mant J, Walker MF. ABC of stroke. Chichester : Wiley-Blackwell, 2011
- Fields WS, Lemak NA. A history of stroke : its recognition and treatment. Oxford : Oxford University Press, 1989
- ebooks and ejournals available online to members [email library@rcplondon.ac.uk for a password] include:
Historical highlights from the library, archive and museum collection
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.