Hi,
Aside from EMGs, what are procedures *commonly* performed by outpatient Neurologists?
Thanks, Frank
Aside from EMGs, what are procedures *commonly* performed by outpatient Neurologists?
Thanks, Frank
Originally posted by scully
I have heard that some private practice Neurologists are investing in the equipment so that they can perform and read their own MRIs, CTs, etc... This isn't exactly a procedure, but it is a new role, isn't it? Does anyone know how common this is?
Originally posted by dcw135
Oh yeah, I forgot BOTOX. That's crazy money. Like 500 a pop - it takes 5 minutes. And neurologists use it for lots of things in addition to dystonias, hemifacial spasm - some are using it for migraine. Some are using it for derm things and there's recently been some editorializing in the journals about this trend.
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I'm credentialed to do the following (all for adults only):
Direct endotracheal intubation, fiber-optic intubation, bronchoscopy, chest tube placement, lumbar puncture, epidural anesthesia, central venous catheter placement, PA catheter placement, hemodialysis catheter placement, arterial catheter placement, thoracentesis, paracentesis, muscle biopsy, skin biopsy, IV conscious sedation.
I'm credentialed to do the following (all for adults only):
Direct endotracheal intubation, fiber-optic intubation, bronchoscopy, chest tube placement, lumbar puncture, epidural anesthesia, central venous catheter placement, PA catheter placement, hemodialysis catheter placement, arterial catheter placement, thoracentesis, paracentesis, muscle biopsy, skin biopsy, IV conscious sedation.
Only in so much as training and reimbursement gives preference to one or two specialties. EMG/NCS is pretty much strictly in the purview of neurology today because they are trained to do them and can be paid to read them, but it's not like neurologists are the only people smart enough to perform or interpret the studies. Anybody and their mother can do Botox these days, and physiatrists have really run with that ball for neurorehabilitation (which I am totally in favor of).
Context matters. The ability to perform procedures is fine, but it's the knowledge and experience of how to apply them and when to use them that makes specialists effective. That's how we prove our worth, and why we are "exclusively" needed. Sure, the procedural library of neurointensivists, pulmonary critical care intensivists, and anesthesia critical care intensivists are highly overlapping, but the training and experience are sufficiently different that outcomes have been demonstrated to be better for patients matched to ICUs tailored to their disease.
I was trained as a neurology resident to do EMG/NCS/evoked potentials, but I certainly wouldn't feel comfortable doing them solo without specialty training. There was plenty of EMG/NCS interpretation on my boards, if I recall correctly. Interpretation of EMG/NCS findings is part of the Neurology ACGME milestones project. There's an entire neurophysiology fellowship through ACGME for those that want to do it professionally.
The neurophysiology lab at my hospital is run by neurology. The American Board of Physical Medicine and Rehabilitation lists 11,433 total diplomates certified as of 2014. They aren't all doing EMGs. Just since 1992, there have been > 2500 clinical neurophysiology diplomates. I know there are PM&R people out there who do EMG/NCS, but they certainly don't make up a big part of the practice in my area.
Yeah, that sounds about right. I certainly didn't do 200 EMG/NCS during residency, and I'm pretty sure neurologists need to be neurophys fellowship certified before they can legitimately bill for them.
I'm not sure how this thread has anything to do with inventions / discoveries in the field.
Sure, the procedural library of neurointensivists, pulmonary critical care intensivists, and anesthesia critical care intensivists are highly overlapping, but the training and experience are sufficiently different that outcomes have been demonstrated to be better for patients matched to ICUs tailored to their disease.
Hmmm...this is an interesting statement, mostly since "outcomes have been demonstrated" implies there's good research out there to support this common assertion.
Although I have not done an exhaustive search through the NCC literature, I'm currently in a department that studies and publishes and discusses ad nauseum intensivist staffing and outcomes and I have never heard of such research. In fact, most research indicates the opposite is true.
Please share.
HH
To date, there NEVER has been any double blinded randomized controlled trials that have EVER demonstrated that it is any safer to jump out of a crashing airplane with a parachute then without one. Why? Because there never has been a control group. Could we formulate such a study? Sure, but good like finding volunteers for your control group.
That being stated, if you were in an airplane that was going down, and somebody offered you a parachute, would you refuse because there is no good evidence?
The idea is not to place this concept into our mindsets, EBM is very important to consider; however, sometimes, we do have to be practical.Yes, that was a funny article playfully mocking EBM extremists written more than 10 years ago in BMJ. The authors are probably pleased you enjoyed it so much and have incorporated it into your mindset. (they may be less pleased you have passed this off as a novel or original thought)
The potential and unlikely outcomes benefits from "specialized intensivists" is not similar to the potential benefits of a parachute in sky diving. This is a secondary point of those authors, I suspect. It requires readers and scientific thinkers to consider EBM a little more deeply and arrogant or undeveloped thinkers to be less dismissive.
Let's now return to the putative benefits of intensivists implied to be supported by evidence in the post by typhoonegator.
Thanks, HH