"Neurologists can diagnose, but can't cure"

[Andaaz]

Hi everyone,

I am a medical student who has been extremely interested in neurology for a really long time! However, over the last several months, I have begun to seriously reconsider my decision to pursue neurology. The primary reason for this is because of what I am sure you have all heard many many times.. "Neurologists can diagnose, but can't really do all that much in terms of treatment".

I should make it clear that I personally do disagree with this sentiment...to a degree. Neurologists can indeed have a huge impact on the quality of life of several people, and while they may not be able to (yet) cure Parkinson's or Alzheimer's, they can slow the decline of several diseases, and giving someone the ability to walk again for another 6 months is kind of a cure in itself...
But to be honest with you, I see what neurologists are capable of doing for their patients, and then I see what other specialists like urologists, orthopaedic surgeons, oncologists, etc. are able to do, and I am being drawn to these other specialties for the primary reason that it seems that others are able to do more for their patients!

I realize that this opinion may be somewhat ignorant or misinformed, and this is why I am posting this...I wonder if you disagree with me, and if you do, please enlighten me. More specifically, I know neurology is an extremely broad field, so are there any subspecialties of neurology where you can cure your patients to a greater degree?

The future of neurology is unarguably bright, but I hesitate to make a decision based on what I *think* neurology may perhaps look like in 10 years time, because I know of at least one neurologist who regrets his decision to choose neurology, for this very reason.

Thanks for reading, I would love to hear your thoughts!

Andaaz

---

Members don't see this ad.

 

[EVNS]

You mentioned urologists, orthopaedic surgeons and I agree that there are things they can cure but they are surgeons
You also mentioned Oncologists and Im not sure if you meant they can cure Cancer? Can cardiologists "cure" heart failure? Can endocrinologists cure DM or can Pulmonologists cure Asthma or COPD? Generally speaking as medicine doctors we tend not to cure things but we do leave a lasting impact on our patients lives. We cannot cure parkinsons but sometimes a touch of sinemet can turn things arund 180 degrees. A seizure pt's live can be a living hell and although we cant help them all, we can heolp a significant number.
Neurology is by far the most exciting field in medicine and we are continuously making break throughs.
You never know you might be the one to find a cure of parkinson's disease?

 

[neurodoc]

There are many new options in neurology that allow us to "treat" and even "cure" neurological diseases more effectively today. The treatment of stroke has evolved to the point that we can prevent "brain infarcts" as effectively as cardiologists can prevent MI, using the same thrombolytic drugs. This is a "big deal." The skill of neurologists to "diagnose" stroke is critical in this venue. Neurodiagnostic skill is critical, for example in determining whether an ER patient is presenting from stroke symptoms or something else, such as Bell's Palsy or Carpal Tunnel Syndrome (and yes, I have seen patients that were given TPA for these and other "non-stroke" symptoms....).

MS is another condition with good modern treatment options. So are migraine, epilepsy, and many other conditions.

 

[neurologist]

I can participate in the curing of epilepsy patients by determining that they are valid surgical candidates and getting them to the neurosurgeon for their temporal lobectomies.

Similarly, I can "cure" some of my sleep apnea patients by getting them to lose weight, or get a UPPP or other upper airway surgery.

Occasional home run with tPA for stroke, but I'm honestly still not convinced that it's da bomb (nor do I think it's anywhere near comparable to what's done for cardiac patients, as one of the other posters suggested)

But, yeah, for the most part, neuro is not a "curing" specialty. Most of what you'll do is chronic pain management and holding the hands of the chronically ill and worried well. If you have conceptual problems with that, don't come in.

I hesitate to make a decision based on what I *think* neurology may perhaps look like in 10 years time

Wise decision. Honestly, it's not all that different now than it was 10 years ago, even after "the decade of the brain" . . . There's more "basic science" understanding of things, but the translation to meaningful bedside treatment for those of us in the trenches has been pretty incremental IMO.

 

[primadonna22274]

Perhaps this has something to do with finding myself more drawn to neuro....I appreciate treating quality of life issues and making something better without expecting "cure". I have a strong palliative care interest and am drawn to geriatrics as well. Been a PA for 11 yr, worked in EM and FM and taught PAs a bit...nothing has quite grabbed me yet. I love medicine and the hardest part of being a medical student is knowing I will have to commit to ONE specialty and stick with it throughout my career...so I want it to be meaningful and encompass all the parts of medicine I enjoy most. I do like chronic care. Like long-term relationships with pts. Enjoy older folks who can teach me something. Like kids but don't like parents. Like EM but don't like sewing up drunks at 3am or dealing with drug-seekers. I suppose when I think back I was happiest in FM but I was bored...and frustrated to have to know everything but be master of much less.
Ironically, I hated neuro in PA school and found it intimidating. The past few years I am more fascinated by it. Would appreciate hearing any thoughts from neuro folks on this..."fit" is very important for me professionally, as is being able to make a nice living and pay off my loans and enjoy time with my husband (we're currently living 700 mi apart while I'm in med school and I appreciate him more now....) We don't have kids and are open but I will be 40 when I graduate and 43-44 when done with residency so that's a consideration. Obviously kids are not mandatory or I would have done that already...but would appreciate hearing from others on lifestyle etc in neuro.
Thanks! Lisa

 

[BlackFrancis33]

Its all perception. An orthopedist replaces a hip. The person is never the same, but was fixed to some degree so this is considered a success. A neurologist gives tpa to a stroke patient with an mca stroke, the patient`s hemiparesis improves but is left with a moderate aphasia. I have seen such cases pointed to as proof neurologists can`t cure anything even though your patient can walk. The fact is a stroke the size of your fingernail can put a patient in a locked-in syndrome, you can shove a rod in someone`s femur. CNS disease is so visible. Mild to moderate Parkinson's can seem far more disabling than moderate to severe CHF to the uninitiated, even though your parky patient will live far longer. What cardiologist` s and orthos do is wonderful, don`t get me wrong. We deal with disease of the brain, an organ infinitely more complex than any other. I think the challenge that presents speaks for itself.

 

[neurodoc]

Its all perception. An orthopedist replaces a hip. The person is never the same, but was fixed to some degree so this is considered a success. A neurologist gives tpa to a stroke patient with an mca stroke, the patient`s hemiparesis improves but is left with a moderate aphasia. I have seen such cases pointed to as proof neurologists can`t cure anything even though your patient can walk. The fact is a stroke the size of your fingernail can put a patient in a locked-in syndrome, you can shove a rod in someone`s femur. CNS disease is so visible. Mild to moderate Parkinson's can seem far more disabling than moderate to severe CHF to the uninitiated, even though your parky patient will live far longer. What cardiologist` s and orthos do is wonderful, don`t get me wrong. We deal with disease of the brain, an organ infinitely more complex than any other. I think the challenge that presents speaks for itself.

Well said!

 

[ProgramDirector]

Sigh....it's an urban legend at this point. First off, show me how many diseases other specialties actually cure. What most do is treat, and in the 21st century Neurology has many, many treatments for almost every known disease, and there are more in the pipeline. What I can do or get done for my patients now compared to even a decade ago is incredibly expanded. And unlike a lot of other specialties who seem to be 'refining' their known body of art, the neurology field is still the bleeding edge of medical science and growing.

 

[danielmd06]

No one is curing anything. Surgeons just cut stuff out or add it in. Medical doctors are just managing long term stuff like diabetes, HTN, HL, CAD, or whatever. Radiologists look at pictures. Pathologists look at slides. ER docs triage to everybody else. Yeah, I'm generalizing, but then so is the "neurologists can't cure" comment.

I think what people REALLY mean is that most neurology patients often don't show dramatic changes in a timeframe that other physicians have come to expect. For instance, stroke patients can improve, but it may take months. Often, when you discharge them from the hospital after two weeks, they look little different than when you admitted them.

It's sort of a circular argument. The problem is few think of it carefully for long. Neurology patients can be frustrating in that they don't get better *fast* in lots of cases...and if this bothers you then neurology may not in fact be for you. It's one of the reasons I like practicing just pure sleep medicine. I missed seeing people get better relatively quickly.

 

[Mattchiavelli]

Its all perception. An orthopedist replaces a hip. The person is never the same, but was fixed to some degree so this is considered a success. A neurologist gives tpa to a stroke patient with an mca stroke, the patient`s hemiparesis improves but is left with a moderate aphasia. I have seen such cases pointed to as proof neurologists can`t cure anything even though your patient can walk. The fact is a stroke the size of your fingernail can put a patient in a locked-in syndrome, you can shove a rod in someone`s femur. CNS disease is so visible. Mild to moderate Parkinson's can seem far more disabling than moderate to severe CHF to the uninitiated, even though your parky patient will live far longer. What cardiologist` s and orthos do is wonderful, don`t get me wrong. We deal with disease of the brain, an organ infinitely more complex than any other. I think the challenge that presents speaks for itself.

Or the orthopedist replaces a hip and causes a periop stroke, then yells at the patient that it's "Not [his] problem". Then the stroke rehab doc helps the patient regain some semblance of a life afterward