Neurology: Fact or Fiction?

There are several threads on this about why someone would go into neurology, how it compares to...say, internal medicine, etc.

I'm getting ready to start residency in June, and I can just tell you a couple things.

1. I think this idea of diagnosing without treatment is more myth than truth, yet it continues to be perpetuated. It's true, our cache of pharmaceutical therapies are probably more limited than other medication classes, but that doesn't mean neurologists do not do anything for their patients. Much like internists and other specialists treat patients for chronic disease (think hypertension...diabetes), finding a good therapeutic regimen for a patient takes time. Some diseases are not reversible, but if you think about it...there are non-neurologic diseases that are similar - glaucoma would be an example.

2. Neurology was my first clerkship as an M3. Of course, I didn't mind this because my original impression (from what I gathered in my neuroscience courses) of the specialty was that I'd get it out of the way since I couldn't stand neuroscience. Turns out, I really loved being neurology...and I really love the neurologic exam - it's a dynamic puzzle for me. I refused to change my mind about the specialty I wanted to pursue during my third year until I was on neurosurgery as part of my surgery clerkship. I loved the surgeries, and I loved the neuroscience of it all, but I found that I didn't think like a surgeon. Even though I had wanted to do emergency medicine, the stuff I really liked were acute neurologic issues. Combined with the fact that I think like an internist, I decided neurology (and possibly neurocritical care because of my interest in acute neurology) was for me. This was further supported by the electives I did in cerebrovascular disease.

3. When it came down to it, my decision to go into neurology didn't have to do with the lifestyle. It had more to do with what I really loved. I liked most of my rotations in my clinical years - but I was always most excited about patients who had signs and symptoms related to neurology.

So, my advice to you - find your passion. If you're passionate about a specific area in IM, then go for it...if finding reflexes floats your boat - then by all means, go for it!

That's just my $0.02...ymmv. I know you wanted practicing neurologists, but I thought you might want the perspective of someone who had an epiphany and found her passion.

-Tomi

Glaucoma may be reversible (surgically) without a need for taking chronic medications, or at least "arrestable" before permanent optic nerve damage occurs.

There are new treatments for stroke (thrombolysis), that can prevent lasting disability (again, if instituted before irreversible neuronal damage has occurred).

Medical science progresses, and more and more diseases are becoming treatable, evn curable, including classic neurological disorders. Stroke is a leading cause of morbidity and mortality, and neurologists now can do much more about it than in years past. When my cousin trained did his neurology residency in the 1960's state of the art treatment included having patients breath into a paper bag (on the hypothesis that increasing pCO2 would increase cerebral perfusion). We've come a long way since then...

Nick

I posted this on another thread, but...

"Last I checked, there was a whole encyclopedia of antiepileptics, in addition to Botox, Phenol and EtOH injections, headache prophylactic agents, headache abortives, anti-spasticity agents, medications to slow the progression of dementia, peripheral anticholinesterases for myasthenia (both short and longish acting), thrombolytics, GPIIIaIIb inhibitors, other anti-platelet and anticoagulant drugs (Aggrenox, ASA, heparin, Lovenox), steroids (IV and oral), rituxumab, IVIg, plasmapheresis, interferons, Tysabri, copaxone, chemotherapy agents, antivertigo and antinausea drugs, interventional procedures including the use of the Merci device, intravascular stents and coils, devices that can be programmed and adjusted after implantation by our surgical colleagues (VNS, DBS, baclofen pumps), anti-virals, CNS antibiotics, anti-neuropathic pain meds, therapeutic high-volume LPs, and a plethora of other treatments that neurologist administer and prescribe."

Now, while there may only be a few Alzheimer's drugs, and none of them reverse dementia, these treatments do all cure, improve, slow, or palliate. Man, I didn't even put the Parkinson's drugs on there. Or the psych meds that neurologist use for various conditions. Or Riluzole. What was I thinking?

And we just treated a patient with Albendazole for neurocysticercosis.

I think it's pretty common for people to be interested in both neurology & IM. Both fields require problem solving, being able to think about complex issues and being involved with your patient's & their chronic illnesses. I was trying to decide between them, and also for a while between neurosurgery as well. For me if I had gone into medicine, I would always wonder, what are those neurologists seeing in their clinics & doing with their patients. But that's not my only reason for choosing neuro. lifestyle factors didn't make a difference, because within either IM & neuro there is more variety in lifestyle than between them.

Here is another thread that started with someone posting about deciding between neuro & neurosurgery. It has a lot of good points & some bad ones (obviously depends on what side you are on). Read it with an open mind, put on some extratolerant skin & make your mind up for yourself. It's your career not the anonymous poster's!

http://forums.studentdoctor.net/showthread.php?p=4377096#post4377096

Final tips:
-Do electives in both.
-Choose a career for you, not your current peers.
-Make sure you like the "bread & butter" common day to days stuff as well as the interesting odd things that happen in your field.
-Think of what your practice & life will be like after qualifying (imagine yourself in an attending's shoes). In the clinics, on the wards or in the labs & lecture theatres.
-Both fields contribute tremendously to patient welfare & to science, so congrats on what ever you choose.😎

You'll hear people bad-mouthing everyspeciality in healthcare, don't listen to them, we do it because as healthcare providers (& wannabies) we are all damaged goods🙁 , but this will change slowly.😀