Were you the one WisNeuro who wanted to get into doing medico-legal as well?
Medico-legal assessments
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I may dip my toe into that pool after a few years of clinical practice. I work with people who do them already, so I'd like to get a little mentoring first.
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About 20% of my clunical patients are tumor pts. About 8 awake craniotomoies a year.
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Most populations can be "interesting" to work with, it just depends what interests you. I personally don't have much interest in stroke evals, as nuanced differences on neuropsych testing don't really lead to changes in treatment recommendations.
As for tumors….those are much more interesting to me. They only make up a small % of my overall practice, though they can be some of my most interesting cases. I see mostly frontal and/or temporal cases (the majority post-resection, though some pre & post cases), so presentation can vary quite a bit. From a teaching perspective I find these to be great cases to review functional neuroanatomy, as there tends to be a ton of pre/post imaging and documentation of functional changes. They can also be challenging cases because a patient can present as high functioning and they think they are 100%, though due to personality changes and/or executive dysfunction the way in which they actually function is quite different. These tend to be the cases where I get a frantic phone call from a PCP/GP/Neurologist who is dealing with a distressed spouse and the patient is trying to return to work w/o any other treatment post-surgery.
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Same as WisNeuro--I hardly ever see folks for tumors at my current location, although I've had a small handful with a history who are post-treatment. As was mentioned, unless you're working specifically in/for a neuro-oncology clinic, it's likely to be pretty rare.
But stroke, yep, very common. And when you just throw "vascular" as a whole in there, that's probably 2/3 of the folks I see (in addition to other possible conditions).
But stroke, yep, very common. And when you just throw "vascular" as a whole in there, that's probably 2/3 of the folks I see (in addition to other possible conditions).
I'm on fellowship at a large medical center where we see a good number of stroke and tumor consults on both the inpatient and outpatient side. There is a neuropsychologist here involved regularly with the awake craniotomies, at least one or two per month. Not my cup of tea, but I'm glad to have the exposure.
Why early onset dementia?
Why not your cup of tea?
With the intraoperative tumor stuff, and also WADAs with epilepsy patients, I dont like being tied up in a surgical suite all day or even 1/2 day when I have reports to write, inpatients to see, and other patients to get back to. Some people love that stuff. It just doesnt interest me that much to eat up such a huge part of my day.
Why do I like the atypical dementias? Well, you dont see them everyday, and they require a very experienced hand to evaluate in terms of differentials. Referring docs, families and patients (if still with it enough) really appreciate the help with diagnosis and guidance on the recommendations.
Why do I like the atypical dementias? Well, you dont see them everyday, and they require a very experienced hand to evaluate in terms of differentials. Referring docs, families and patients (if still with it enough) really appreciate the help with diagnosis and guidance on the recommendations.
Yeah, atypical dementia does seem interesting even in the sense that you are seeing younger patients. Maybe it is just me but I would also prefer to work with younger patients..and most of these issues are later-life issues in a general sense (dementia, stroke etc)
I personally dont prefer younger patients. I actually prefer older folks. Its good to be exposed to a range while in training. For a while in grad school I thought I wanted to work with kids and did a peds practicum, which promptly fixed that.
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I like the older folks, they tend to malinger less often in my setting.
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I really enjoyed working with kids, though their parents….pain in the butt. I stick with 16-65+ now.
RE: WisNeuro…kid malingering is much easier to deal with than adult malingering.
RE: WisNeuro…kid malingering is much easier to deal with than adult malingering.
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Oh, I've dealt with both, just no kids recently. Kids tend to come clean when confronted, whereas the adults will stick to their guns, no matter how ridiculous they are.
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Like being able to recall every single doc they've seen and for what, but then magically not being able to name family members or "remember" anything since the slip and fall at work? They also magically remembered the pain medication that "worked" (dilaudid), and all of the (non-opioids) pain meds that didn't. That dilaudid…it's a miracle med!!
That alone makes me want to do neurpsych lol
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The problem is that those patients can take up an inordinate amount of time/resources. Angry phone calls, threats to sue, no-shows, etc.
It is a long road to do it right. I love the work, but some days I wish I owned a fishing boat in the Caribbean instead.
It is a long road to do it right. I love the work, but some days I wish I owned a fishing boat in the Caribbean instead.
I wouldn't really take too kindly to people lying. They would get a big slap! Then I would get out the whips and chains!
haha jk
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