What are some things that set apart a good neurologist from a “let’s just say I won’t send my family to this person” neurologist?

[deleted1139416]

I just finished my third year. After reflecting on this past year, having worked with 20+ attendings, I’m really getting into thinking about the kind of doctor I want to be. So, what sets apart a good neurologist?

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[DrSatan]

Empathy, communication skills, and having a thoughtful approach.

 

[deathmerchant]

Empathy, communication skills, and having a thoughtful approach

Other than doing your homework on learning Clinical Neurology well and staying uptodate with new data/studies- I would say most of my good reviews from patients are something about- "listened to me" and "explains things well".
Few things that I personally always do -
1. Never look at a screen or type notes in the patient room.
2 Always talk about at least one personal thing with the patient like their family, job, hobbies etc
3. Being non judgmental. I think it's very important to realize we as doctors don't always know everything and have been/are wrong about science and 'sometimes' patients know more about their disease/symptoms than we do. This part is especially important with functional disorders.
4. The hardest thing is, which you get better with experience is individualizing your approach to each patient. What is their level of understanding and and at what level/and how you should explain things to them and how much time they need etc. Something that works with one patient might not work with another.

 

[Spinothalamic]

Totally agree with deathmerchant.

I always ask their occupation or at least some non-medical question, often while checking reflexes.

Try to treat each patient like they were your sister or brother, or remember that they are someone’s son/daughter, or remember that they were created uniquely by God if you believe that. This is hard to do sometimes but if you practice remembering this during frustrating patient encounters it gets easier over time.

I really think that time spent with patients is critically important. Countless times I have made non-neurologic diagnoses (not even counting the neurologic diagnoses) because I just simply let the patients explain their symptoms—who would have thought??? There is a reason that many talented neuro-ops say that their best advice is something like “listen to the patients and they will tell you the diagnosis”

One could argue that you could spend much less time with patients and still make the same diagnosis and treatment plan. However, that doesn’t take into account the fact that more time spent with patients may lead to better disease expectations, less anxiety, less medication cessation due to temporary side effects, etc. These can all improve patient outcomes when most treatments in neurology have major psychosocial factors

I personally type while in the exam room but always make sure to be facing the patient, mostly looking at the patient, and stop typing during important moments in the history.

Finally, intellectual humility. “Once the diagnosis is made, the thinking stops”. Signs and symptoms evolve over time—don’t get locked into being stuck on a diagnostic/therapeutic pathway if new clinical information comes to light. Also keep in mind rare pathology is hiding in every general neurology clinic. It’s not common obviously but have a low threshold for further investigation if things aren’t behaving/responding typically.

 

[Aldertonghen]

Other than doing your homework on learning Clinical Neurology well and staying uptodate with new data/studies- I would say most of my good reviews from patients are something about- "listened to me" and "explains things well".
Few things that I personally always do -
1. Never look at a screen or type notes in the patient room.
2 Always talk about at least one personal thing with the patient like their family, job, hobbies etc
3. Being non judgmental. I think it's very important to realize we as doctors don't always know everything and have been/are wrong about science and 'sometimes' patients know more about their disease/symptoms than we do. This part is especially important with functional disorders.
4. The hardest thing is, which you get better with experience is individualizing your approach to each patient. What is their level of understanding and and at what level/and how you should explain things to them and how much time they need etc. Something that works with one patient might not work with another.

I deliberately ask and put a random thing like “they have a farm where they grow tomatoes” in my note and the next time they show up to my continuity clinic I ask them how their tomato farm is- instant approval

 

[Postictal Raiden]

When possible, grab a chair and sit down. This in itself portrays that you’re available for your patient and not just trying to rush through another encounter.

 

[Hank_Hill_MD]

Agree with all of the above.

A wider differential than "idk, maybe autoimmune encephalitis or primary CNS vasculitis" every time something unfamiliar comes up on an MRI is also good.

 

[Telamir]

Solumedrol 1G daily for 5 days. What’s that? Ends on Tuesday? Sounds like the other guy’s problem PEACEEEEEEE

Been in this situation too many times haha.

 

[deleted1139416]

I have noticed that neurology is unique in that you have to spend a lot of time with the patient to get a good history and a good idea of what is going on. But cuts in medicare reimbursement make that almost impossible to do for every patient. What do you guys think?

 

[Postictal Raiden]

I have noticed that neurology is unique in that you have to spend a lot of time with the patient to get a good history and a good idea of what is going on. But cuts in medicare reimbursement make that almost impossible to do for every patient. What do you guys think?

Bill higher

 

[deathmerchant]

I have noticed that neurology is unique in that you have to spend a lot of time with the patient to get a good history and a good idea of what is going on. But cuts in medicare reimbursement make that almost impossible to do for every patient. What do you guys think?

Time management and learning to document and bill appropriately helps a lot. Many neurological diagnoses are already moderate to severe complexity which can be billed higher with proper documentation. Also patients with dementia and other cognitive issues can be billed a much higher code at every followup. Neurology is also one of the highest in-demand specialty so you can negotiate a higher RVU rate. We don't have many procedures but with the above you can make a decent living!

 

[Lots of Snow]

Also patients with dementia and other cognitive issues can be billed a much higher code at every followup.

How’s that?

 

[FutureInternist]

Don’t be one of these… 😂

 

[Postictal Raiden]

How’s that?

Billing based on time spent. Also these neuro degenerative cases are so complex since they have a host of symptoms related to the condition (constitution, salivation, orthostatic hypotension, spasticity, frozen shoulder, etc).

 

[deathmerchant]

How’s that?

check out requirements for- 99483, can be billed every 6 months for patients with dementia/complex neuro issues

 

[Atlas1496]

I have used this several times. Especially when family specifically asks for a moca to be repeated.