Lighter On Stroke

[clement]

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[95439]

Well you have to consider that there literally is a "Stroke belt" in the US (mainly midwest to southeastern states). Coincides with obesity rates. Avoid Houston and Atlanta if you want to avoid 'stroke capitals'.

 

[typhoonegator]

Stroke is a big part of what most academic neurology programs at tertiary care hospitals are expected to take care of. Hospitals want stroke accreditation, and the stroke division tends to be a big part of the public face of a neurology department. It's also a top 3 cause of death and disability, so you aren't going to find many big places that don't devote some serious attention to it.

Even places with big stroke programs still expect residents to be involved in the process, so it's not like you can always just defer to the fellow/attending. Residents have to manage the inpatient and consult services, so you can't completely escape it.

If you are dead-set on avoiding stroke (and I can't tell you how much I disagree with that attitude) then you'd be better off looking at smaller programs that might live in the shadow of a nearby big institution. Places like that might have a procedure to ship their acute strokes to the bigger center, freeing you up to have a lower acuity resident experience/education.

 

[95439]

4th leading cause of disability/death now. Come on TN.. ;o)~

Please don't ban me

 

[Neuropil]

Another option would be to consider child. I found stroke to be really boring too.

 

[HarveyCushing]

4th leading cause of disability/death now. Come on TN.. ;o)~

Please don't ban me

I think that is a more recent change. Has been

1) Heart disease
2) Cancer
3) Strokes

for a long time. Now that it has dropped to #4 I bet that is partly due to the better diagnostic and treatment options.

Btw WHO claims strokes is #2 world wide

http://www.who.int/mediacentre/factsheets/fs310/en/index.html

 

[95439]

They were quite adamant at the 2012 international stroke conference that it's now #4. Likely depends on the source of info and who benefits from what rank.

 

[danielmd06]

They were quite adamant at the 2012 international stroke conference that it's now #4. Likely depends on the source of info and who benefits from what rank.

What's number three? Cardiovascular disease and cancer have to still be one and two...

 

[HarveyCushing]

What's number three? Cardiovascular disease and cancer have to still be one and two...

I bet it depends if you include just medical diseases vs also adding MVCs to the list.

 

[RAD345]

1 Diseases of heart
2 Malignant neoplasms
3 Chronic lower respiratory diseases
4 Cerebrovascular diseases
5 Accidents (unintentional injuries)
6 Alzheimer’s disease
7 Diabetes mellitus
8 Nephritis, nephrotic syndrome and nephrosis
9 Influenza and pneumonia
10 Intentional self-harm (suicide)
11 Septicemia
12 Chronic liver disease and cirrhosis
13 Essential hypertension and hypertensive renal disease
14 Parkinson’s disease
15 Pneumonitis due to solids and liquids

Ref:http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf

 

[neurologist]

Don't know if anyone has any answers to this or prefers to PM me....Is there such a thing as neuro programs out there that are NOT super stroke heavy? Or ones where there is a strong stroke team presence, enough to relieve the gen residents of at least some stroke work? I hear midwest programs tend to be "stroke heavier." Not sure if geography plays a huge role in this...

If you really don't want to do much stroke, do yourself a favor and either:

1. Don't go into neuro at all, or

2. Suck it up during residency (stroke, while not particularly interesting, is also not particularly difficult, except for the 2 am TPA calls), and then go into some non-stroke-heavy subspecialty and try to tailor your career accordingly.

Although I never liked stroke that much either, I don't advocate stinting on it during residency, the main reason being that you need to know how to recognize and differentiate the stroke look-a-likes, so you can see a patient and realize "ya know, this really isn't a stroke, it's a complicated migraine" and not shoot them up with TPA unnecessarily.

 

[neglect]

I'd argue that if you're poor at stroke, then it is hard to be good at anything in neurology. I find myself asking myself 'is this patient focal?' and the only way to answer yes or no is to have seen and learned from tons of stroke. Who said that neurologists learn neurology stroke by stroke? I forget, but it is true.

 

[HarveyCushing]

I'd argue that if you're poor at stroke, then it is hard to be good at anything in neurology. I find myself asking myself 'is this patient focal?' and the only way to answer yes or no is to have seen and learned from tons of stroke. Who said that neurologists learn neurology stroke by stroke? I forget, but it is true.

Here here. Sure beats the chest pain rule outs.

 

[Birdstrike]

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[clement]

I can live with stroke...it's neuro icu that's not my fav but it's not as prominent in all programs.

 

[neglect]

Here here. Sure beats the chest pain rule outs.

The other cool thing about stroke, as opposed to so much in neurology, is that it is very action driven. You get good at diagnostic eyeballing and then acting on it on the happy times when you give tPA - a real chance to make a patient much better for the remainder of their life.

Honestly, I didn't find stroke all that compelling when I was getting hammered by the ER as a resident by people who thought "stroke can do anything." But I've grown more fond of it as time has gone on. The other thing about stroke is that no-one else is at all good at it, so they overuse diagnostic tests like crazy.

 

[Hank Rearden]

Stroke rocks and I agree with the other posters that it's the best way to learn neuro.

The answer to your question is simple. Inpatient = stroke, outpatient = little stroke. Find the residency program with the least inpatient months and lowest inpatient census and you will see the fewest strokes. Just be warned that empty beds make empty heads.

 

[Mattchiavelli]

Stroke rocks and I agree with the other posters that it's the best way to learn neuro.

The answer to your question is simple. Inpatient = stroke, outpatient = little stroke. Find the residency program with the least inpatient months and lowest inpatient census and you will see the fewest strokes. Just be warned that empty beds make empty heads.

That's a good aphorism and I'm stealing it I think a better distinction would be whether the stroke patients in an ICU type setting are primary neurology patients.. you do need to see a lot of strokes mainly to understand when someone is -not- having a stroke. Not assuming a lot of the care in an ICU is definitely a place where programs differ especially in open vs closed ICUs