At present, neurologists” diagnostic capabilities outstrip their treatment armamentarium, and this gap looks set to widen as specialties such as neurogenetics expand. On the other hand, exciting and controversial developments have recently occurred in the pharmacological treatment of previously untreatable disorders such as motor neurone disease (riluzole), multiple sclerosis (interferon beta), and dementia (donepezil). In the future neurologists will probably have a pivotal role in the coordination and, unfortunately, rationing of such treatments. Patient management is not restricted to specific treatments, and there are many ways in which neurologists help to ease the burden of chronic disease in their patients. This is usually as part of multidisciplinary care, and team management, coordination, and good communication skills are essential.The illnesses encountered must be among some of the most fascinating in medicine. This interest is increased by the fact that neurologists use some of the best toys in the hospital, the scanners, to investigate their patients. Imaging has not de-skilled neurology, however, and diagnosis and management of most conditions rely on clinical skills. As it is generally considered a complex and difficult postgraduate specialty, many medical students (and doctors) have been discouraged from fully getting to grips with the neurological examination. This lack of familiarity with neurological disease ensures that a neurologist can often pull a diagnosis out of the hat with a baffling case just by being able to take a careful history (most neurologists have obsessive personality traits) and perform an adequate neurological examination. It also means that neurology trainees are especially popular in the run-up to MRCP examinations.