Clinical Neurology and Neurosurgery 112 (2010) 839–843 Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro Challenges to neurosurgical professionalism Ayhan Kanat a,* , Clara Raquel Epstein b a Rize University Medical School, Department of Neurosurgery, 53100 Rize, Turkey b Boulder Neurosurgery Center, LLC., 1320 Pearl Street, Suite #240, Boulder, Colorado, USA article info Article history: Received 4 March 2009 Received in revised form 3 April 2010 Accepted 16 July 2010 Available online 13 August 2010 abstract At present, neurosurgical practice is confronted by an explosion of technology. Rapid advances in neu- rosurgical knowledge and technology are putting increased pressure on neurosurgeons to process huge quantities of information, with requirements for continuous learning and updating scientific knowledge and skills which are time consuming but essential. Changes to the venerated status quo of neurosurgical practice have created an environment that may have a negative impact upon neurosurgical professional behavior. As a result, neurosurgeons may find it increasingly difficult to meet their moral and ethical responsibilities to patients, trainees and colleagues, and society. In these circumstances, reaffirming the fundamental and universal principles and values of neurosurgical professionalism, which remain the ideals to be pursued by all neurosurgeons, becomes all the more important. © 2010 Elsevier B.V. All rights reserved. 1. Introduction The subject of professionalism is often referred to in the medical literature, but the word itself is rarely defined—and it is assumed that physicians understand what it means to be professional and use this understanding as they make decisions in their private and professional lives [1]. 1.1. Evolution of neurosurgery The practice of surgical manipulation of the nervous system and its coverings has been evident for more than 12,000 years, and the settings in which these practices have been conducted have reflected the state of the art, science, and, indeed, pur- pose of these endeavors. Although neurosurgery may be one of the younger surgical specialties, having Sir Victor Horsley among its most celebrated fathers, it may also be one of the most rapidly changing. There are several reasons that drive this evo- lution, including technological advances, socio-economic factors and expectations of patients [2]. There have been major changes in the practice of neurosurgery in the last decade [3]. Subsequent advances in microsurgical techniques, non-invasive neuroimaging, neuroanaesthesia, intensive care, image-guided surgery, and the introduction of sophisticated radiosurgical, neuro-oncological and interventional radiologic treatments have changed and widened the scope of neurosurgical practice. The most striking changes are in three subgroups—stereotactic and functional neurosurgery, vas- * Corresponding author. Tel.: +90 535 3906975. E-mail address: ayhankanat@yahoo.com (A. Kanat). cular and spinal surgery. Each have undergone major advances over the past decade. Stereotactic and functional neurosurgery has evolved with scientific applications and technological advances, with more universal acceptance and with incremental use. Devel- opment and implementation of stereotactic radiosurgery has resulted in a reduction in the total number of brain and spine lesions. Advances in functional neurosurgery have led to greater indications and procedures performed, particularly with implanta- tion of neurostimulators. This is fuelled by: (i) improved imaging; (ii) advances in scientific knowledge and progression of technol- ogy enabling enhanced placement of deep brain electrodes and implantable pulse generators; and (iii) safety and public accept- ability factors which favor a nondestructive, reversible technique (such as neuromodulation) to lesioning. Neurosurgery is a rapidly evolving speciality. The progress, pre- viously long and laborious in emergence, is currently undergoing rapid evolution. There have been great changes in the previous decades and it is likely that the rate of change will increase further, given that the speed of technological advancement and modern- ization of surgical training is increasing rapidly [4]. While scientific knowledge and technical skills are crucial in all areas of medicine, they are particularly critical in neurosurgery, and the manner in which they are applied is equally important. It has also become common place to argue that increasing resources will not neces- sarily produce any good if not spent effectively. Thus, when more money is promised for health care, it is done under the condition that it can be proven that the money will be and has been spent on effective interventions. This trend has created an unprecedented need for the neurosurgical profession to explicitly justify its actions in both medical and economic terms. It is clear that neurosurgeons have felt discomfort as the neurosurgical health care system is 0303-8467/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.clineuro.2010.07.012