Questions for neurologists

[average]

I am a third year MS and am seriously considering neurology.

I would like to know, from those of you who are in neurology:

1. what it is that drew you to neurology in the first place.

2. We all have our ideas of what it will be like starting something new. What kinds of things did you run into that surprised you? Good or Bad

3. Does stroke become uninteresting over time? I keep hearing people say that one of the downsides is that all you get to deal with is stroke. Personally, I don't have a lot of experience but find the phenomenon of stoke rather interesting.

Thankyou for any assistance

---

Members don't see this ad.

 

[Arctic Char]

i'll transfer my original post here, and hope we can both get some replies:

Anyone regret neuro?
---------------------
I thought i'd ask the question in hopes of hearing potential responses. I have some fears/uncertainties about going into Neuro - namely, tedium of disease management vs effective intervention; but i'd like to know if anyone out there prepared for this and still likes neuro, or prepared for this yet regret their decision to enter the field.

anyone? i'd love some feedback.

cheers

 

[penguins]

I am not a neurologist.... yet. I am interviewing for spots right now.

I got lots of negative reaction when I decided to go for neuro. Mainly comments like, "all you get to see is stroke." I don't think that is true at all! I think most docs are somewhat intimidated by neurology and don't know much about it so it makes it an easy target for criticism. On my inpatient neuro rotation I did see lots of stroke. I also saw an equal amount of other fun stuff. If you love vascular you could do a fellowship in it and do that all the time. There are tons of other things though.

If you find it interesting, however, that is a sign! I was so bored in surgery after the first few procedures. I can't imagine doing that with my life. Talk to another student and they adore it and can't imagine doing anything else. It is whatever your niche is and not everyone is going to like the same thing. That is the joy of doing all these rotations. Sometimes you fall in love with a specialty you never would have guessed. Until I did my first neuro rotation, I had no desire to do it and now I can't imagine doing anything else.
Another thing I like about neuro that the outsiders often dislike is that it is more academic than some other specialties.

Just my own opinions. I got lots of strange looks and similar criticism so wanted to share.

 

[neurologist]

I am a third year MS and am seriously considering neurology.

I would like to know, from those of you who are in neurology:

1. what it is that drew you to neurology in the first place.

2. We all have our ideas of what it will be like starting something new. What kinds of things did you run into that surprised you? Good or Bad

3. Does stroke become uninteresting over time? I keep hearing people say that one of the downsides is that all you get to deal with is stroke. Personally, I don't have a lot of experience but find the phenomenon of stoke rather interesting.

Thankyou for any assistance

1. Believe it or not, it was neuroanatomy. This is what usually scares people away, but I found all those pathways really interesting. The logic of it somehow appealed to me. It's really just a roadmap or a circuit diagram. Also, the presentations of many neurologic diseases (epilepsy, stroke) can be fascinating.

2. The biggest negative surprises to me have been 1) how much neurologists deal with chronic pain problems and 2) how many of your patients have really significant psychiatric problems. Unfortunately, I think most neurologist-wannabes don't realize this until pretty late in the game, because med school and early residency are geared toward the acute care hospital setting (i.e., stroke, seizure, neuro trauma, etc). It's only once you start your outpatient clinicals and electives (or even get into practice) that you realize that most of your life is headache and back pain and depression. I don't think it would have changed my career choice (you can always sub-sub specialize, which is what I plan to do) but I would have had a more realistic idea of what outpatient neurology was like. On the good side, I was happy to see that neuro is continually coming up with more options for patient treatment -- definitely an exciting, expanding field, and not the "diagnose and adios" of days gone by.

3. Depends on how far you want to follow patients after their stroke. In my opinion, stroke is interesting as far as the presentation, initial clinical workup, and acute treatment, if any. After the first 24 hours, you are more or less left with a rehab case. Now, of course, there are some people who are into neurorehab, long-term risk factor management, etc., and you can always learn some interesting practical neuroanatomy stuff, but the followup of post-stroke patients is not for the adrenaline junkies who want to shoot that TPA in the ER or throw in a coil in the angio suite.

 

[bustbones26]

1. what it is that drew you to neurology in the first place.
Like medicine but didn't want to do internal medicine, like neuro as a specialty. I personally like neuroanatomy and I do think that in my medical school years, we had great education in this area, so for this reason, more ppl than average in my class pursued neurology. I also chose it for personal reasons. Neuro is a specialty where you can work hard, but the call is not too brutal. I certainly am not afraid of more brutal specialties, but again, with personal things going on in my home, I think neurology will allow me to escape from medicine when I am needed at home. Lastly, I was not bored in neuro clinic. Just like any other specialty you do see the same thing over and over, but for some reason, seeing MS, parkinsons, stroke etc, over and over never seemed to bore me, at that point I realized that I enjoyed neuro

2. We all have our ideas of what it will be like starting something new. What kinds of things did you run into that surprised you? Good or Bad
Good things: Lots of opportunity to do procedures if you want to take the time to learn them: botox, carotid US, etc. Also, although many subspecialties of neuro exist, not all are boarded. So you really don't need to do a fellowship in most areas to prove your expertise, just need to prove you see enough cases/procedures and keep current on CME

BAD: Neuro is a subspecialty of internal medicine, yet you don't have to complete an entire IM residency to do neuro. It has been aggravating for me when I suggest that a patient need something and the attending say, "Oh no we can;t do that because we are not the primary care physician, we are just the consultant", yet at other times, they just in and change orders to manage blood pressure, diabetic meds etc because the primary doc is not doing it adequately. I say don't pick and choose when you feel like being consultant only and the times when you feel like jumping in and doing medical management on the side. Do one or the other.

3. Does stroke become uninteresting over time? I keep hearing people say that one of the downsides is that all you get to deal with is stroke. Personally, I don't have a lot of experience but find the phenomenon of stoke rather interesting.
Do doing cholecystectomies get boring over time to a surgeon? Delivering babies boring to an OB/GYN? OK so you get my point, not matter what specialty you choose, there is going to be repitition. So choose a specialty where what it is you see/do on a regular basis is not stuff that bores you to death. The cool thing about stroke is that it has a lot of room for improvment. Think about cardiologist and the amazing things they can do these days to save heart tissue, compared to them, neurologist are cavemen, but we are working on it.

 

[allendo]

I am not a neurologist.... yet. I am interviewing for spots right now.

I got lots of negative reaction when I decided to go for neuro. Mainly comments like, "all you get to see is stroke." I don't think that is true at all! I think most docs are somewhat intimidated by neurology and don't know much about it so it makes it an easy target for criticism. On my inpatient neuro rotation I did see lots of stroke. I also saw an equal amount of other fun stuff. If you love vascular you could do a fellowship in it and do that all the time. There are tons of other things though.

If you find it interesting, however, that is a sign! I was so bored in surgery after the first few procedures. I can't imagine doing that with my life. Talk to another student and they adore it and can't imagine doing anything else. It is whatever your niche is and not everyone is going to like the same thing. That is the joy of doing all these rotations. Sometimes you fall in love with a specialty you never would have guessed. Until I did my first neuro rotation, I had no desire to do it and now I can't imagine doing anything else.
Another thing I like about neuro that the outsiders often dislike is that it is more academic than some other specialties.

Just my own opinions. I got lots of strange looks and similar criticism so wanted to share.

What is vascular?

 

[orientedtoself]

What is vascular?

tube-like structures that convey blood

 

[allendo]

tube-like structures that convey blood

I know that but what does a neurologist in this field do?

 

[orientedtoself]

I know that but what does a neurologist in this field do?

I was being funny. I have no idea. ?stents

 

[bustbones26]

Vascular neurology is a fellowship where you basically run a stroke service. Has interchangeable terms depending on the institution: vascular neurology, stroke, cerebrovascular disease, etc. You see/learn more about the vascular anatomy of the brain than the general neurologist: learn how to do transcranial dopplers, carotid ultrasounds, etc. You are directly involved with the hospital's stroke team.

Some programs allow you to extend the fellowship to learn how to do intervention with coil retreival, stents, etc. This portion of the fellowship of course is open to radiologist and neurosurgeons as well. To qualify for this portion of the fellowship as a general neurologist, you have to do the 1-2 years of stroke fellowship first.

This fellowship is not boarded (yet), that is to say, there is no american college of vascular neurology that you sit and take a board exam for when finishing fellowship. For this reason, the curriculum of vascular neurology varies from institution by what you do/learn and length.

 

[Arctic Char]

on the topic of vacular neurology, i think its appropriate to mention autonomic cardiovascular dysfunction. diabetic neuropathies, and various genetic autonomic disorders (DBH deficiency, NET deficiency, NTM pheo's).

hemodynamic abnormalities are frequently the first manifestation of neurological pathologies. managing the hemodynamics of said patients can be an area in which a neurologist can offer a great deal of service.

my two agarot . . .

 

[skb21]

1. Believe it or not, it was neuroanatomy. This is what usually scares people away, but I found all those pathways really interesting. The logic of it somehow appealed to me. It's really just a roadmap or a circuit diagram. Also, the presentations of many neurologic diseases (epilepsy, stroke) can be fascinating.

2. The biggest negative surprises to me have been 1) how much neurologists deal with chronic pain problems and 2) how many of your patients have really significant psychiatric problems. Unfortunately, I think most neurologist-wannabes don't realize this until pretty late in the game, because med school and early residency are geared toward the acute care hospital setting (i.e., stroke, seizure, neuro trauma, etc). It's only once you start your outpatient clinicals and electives (or even get into practice) that you realize that most of your life is headache and back pain and depression. I don't think it would have changed my career choice (you can always sub-sub specialize, which is what I plan to do) but I would have had a more realistic idea of what outpatient neurology was like. On the good side, I was happy to see that neuro is continually coming up with more options for patient treatment -- definitely an exciting, expanding field, and not the "diagnose and adios" of days gone by.

3. Depends on how far you want to follow patients after their stroke. In my opinion, stroke is interesting as far as the presentation, initial clinical workup, and acute treatment, if any. After the first 24 hours, you are more or less left with a rehab case. Now, of course, there are some people who are into neurorehab, long-term risk factor management, etc., and you can always learn some interesting practical neuroanatomy stuff, but the followup of post-stroke patients is not for the adrenaline junkies who want to shoot that TPA in the ER or throw in a coil in the angio suite.

I'm a second year student that hasn't decided on a specialty yet, but neurology is definitely something I may consider. Like you, I found that neuroscience really clicked with me when I took that course. I did very well in it, and I guess because the material really stimulated my mind, I found learning the pathways and disease presentations fairly easy. I don't know if any of you believe in signs, but after doing well in neuroscience, I was assigned to a neurologist in town for my second year clinical involvement rotation. I will be taking a didactic neurology course starting in December, so it will be interesting to see if I do well in that.

As of now, neuro is one of a few specialties I'm considering. I'm a little smitten with the infectious diseases specialty as well, and I also like orthopaedic surgery. The further I go along in this process, the more I feel like I want to go into something that will challenge me, stimulate my mind, and has a broad variety of tasks.

 

[Arctic Char]

skb21 -

if you like ID and neuroscience, you'll love this article as i did. its about parasitic infections and their contribution to neurological/psychiatric disorders. its not like reading a dry article on neurocysticercosis, more artistic and creative. give it a shot, i hope you like it:

http://www.cdc.gov/ncidod/EID/vol8no9/02-0204.htm

-cheers

 

[skb21]

skb21 -

if you like ID and neuroscience, you'll love this article as i did. its about parasitic infections and their contribution to neurological/psychiatric disorders. its not like reading a dry article on neurocysticercosis, more artistic and creative. give it a shot, i hope you like it:

http://www.cdc.gov/ncidod/EID/vol8no9/02-0204.htm

-cheers

Thanks! That is a great article.