Is Neurology Depressing?

[BozoSparky]

At first glance, I find neurology very interesting...however, talking to others (not exactly credible sources) I hear that neurology can be very depressing ...lots of diagnoses with little to do.

Anyway, if anyone has an opinion/experiece, I'd love to hear it.

oh, I am starting M2 in a month, just so you know where I'm coming from.

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[Nerdoscience]

Yes

And No

There are a lot of untreatable diseases in Neurology, and I certainly wouldn't want any Neurologic disease if I had the choice. But isn't that the way all medicine is? I mean, maybe you can't cure epilepsy most of the time, but you can't cure hypertension most of the time either.

And there are a lot of treatments in Neurology, and some cures. It's really not that different from any other field.

 

[Faebinder]

It's true many neuro diseases are untreatable however, it's not true that many are not treatable. Seizures and neuromuscular disorders like mythenia gravis are very treatable.


Sides.. that's what's so interesting about neurology... the fact that so much clinical research is necessary in the future.

 

[BozoSparky]

Sides.. that's what's so interesting about neurology... the fact that so much clinical research is necessary in the future.

I agree...neurology seems full of potential breakthroughs!

 

[bustbones26]

Two major legends of neurology, One, its depressing, and two, its hard.

Yes, there is no cure to most things we see. But there are some bright points to this profession.

1) Even though you might diagnose a patient with a nasty incurable illness, sometimes you generate relief too. Many MS patients are happy to know they actually have something after years of being told they are nut jobs with conversion disorders

2) Once you diagnose a patient with a neurological disease, its your job to take care of them and this is where the doctor-patient relationship forms. Many patients with things like Parkinsons and MS will praise you when you take the time to listen to their complaints and sometimes, go out of your way to help them, even though you cannot cure them.

3) People with seizures and migraines think you are a true hero when you come up with a "new" medication that stops their symptoms.

4) lifestyle. You can be quite busy a a neurologist. That is, if you want to be. Unlike cardiology or most surgical specialties where there is no escape from long work hours, it is entirely possible to make a good living as a neurologist with light work. Yes, you won't make the money of say the neurologist that does work long hours and does high volume work, but you will still make enough money to have your five story house and class E Mercedes.

5) As already pointed out, many new up and coming things in neurology. The reason why nobody seems to understand the difference between stroke, vascular, interventional, ICU neurology is because all of these programs are young and up and coming. They are a work in progress.

 

[bjolly]

it all depends what you find depressing. I'm in the midst of a neuro rotation now and I've seen a little of everything - dementia, seizures, tremor, Parkinson's, MS. The only patient that depressed me was a patient with diabetic neuropathy who wasn't controlling his sugars, wasn't complying with CPAP for his sleep apnea, etc, and basically told us that nothing we do helps him. He was probably more of a typical IM patient than a typical neuro patient.

People tend to think neuro is depressing because we can't cure a lot of the diseases - but that's really true in most fields. You don't cure hypertension, diabetes, CHF, arthritis, etc either. Neuro diseases are similar to a lot of medical diseases - chronic, life altering conditions that you try to manage so you can maximize the patient's quality of life.

 

[bustbones26]

it all depends what you find depressing. I'm in the midst of a neuro rotation now and I've seen a little of everything - dementia, seizures, tremor, Parkinson's, MS. The only patient that depressed me was a patient with diabetic neuropathy who wasn't controlling his sugars, wasn't complying with CPAP for his sleep apnea, etc, and basically told us that nothing we do helps him. He was probably more of a typical IM patient than a typical neuro patient.
.

You make a very good point. Non-compliance is a drag no matter what specialty you choose. But the point I would like to make is that the people with Parkinsons, MS, etc. want helped and do what you tell them. There are some non-compliant ones too, but this is usually due to a misunderstanding with your instructions. Wish I could say the same for seizures, these patients are always non-compliant, the ER guys get to see this all of the time.

But keep in mind, there is no escape from neuro.

If you do IM or FP, you will be the primary care for these people. In the civilian world in private hospitals, you will actually be admitting these patients to the hospital and managing them. Neuro will come only when consulted. You will admit them for a stroke, order their echoes, carotids, give them ASA etc. Its a no brainer (no pun intended)

If you do OB/GYN, you will be seeing pregnant patients with these disorders and have to fear complications and medication teratogenic effects

If you are Emergency Med, you will certainly see these people when they can't control their headaches, pain or seizures when non-compliant.

If you are an ICU doctor, you will have to manage patients will increased ICP, acute spinal cord injuries, and do good and thorough brain death exams.

So what makes neurology a specialty. We are the primary managers of these neurologic illnesses and pretty much give medicine to aid the problem and manage the side effects. Its not that bad, trust me.

 

[neurologist]

If you do IM or FP, you will be the primary care for these people. In the civilian world in private hospitals, you will actually be admitting these patients to the hospital and managing them. Neuro will come only when consulted. You will admit them for a stroke, order their echoes, carotids, give them ASA etc.

Wow! What hospitals are you working at? I would LOVE to be at a place where all I have to do as a neurologist is consults! Neurologists are quite often first call and admitting service. And as for your other comments . . .

If you do OB/GYN, you will be seeing pregnant patients with these disorders and have to fear complications and medication teratogenic effects

. . . and you will call a neurologist to manage her during her pregnancy . . .

If you are Emergency Med, you will certainly see these people when they can't control their headaches, pain or seizures when non-compliant.

. . . and you will "treat and street" them with a referral to a neurologist . . .

If you are an ICU doctor, you will have to manage patients will increased ICP, acute spinal cord injuries, and do good and thorough brain death exams.

. . . and you will be on the horn right away for a neurologist, neurointensivist or neurosurgeon . . .

Believe me, the vast majority of non-neurologists want nothing to do with neurologic issues, which is fine because a) they tend to be totally incompetent with regard to neuro issues; b) it keeps us in business; and c) it goes both ways . . . if you're a neurologist with an epilepsy or MS patient who happens to get pregnant, are you going to manage her pregnancy? Heck no! Off she goes to the nearest OB doc!

 

[bustbones26]

Wow! What hospitals are you working at? I would LOVE to be at a place where all I have to do as a neurologist is consults! Neurologists are quite often first call and admitting service. And as for your other comments . . .

. . . and you will call a neurologist to manage her during her pregnancy . . .

. . . and you will "treat and street" them with a referral to a neurologist . . .

. . . and you will be on the horn right away for a neurologist, neurointensivist or neurosurgeon . . .

Believe me, the vast majority of non-neurologists want nothing to do with neurologic issues, which is fine because a) they tend to be totally incompetent with regard to neuro issues; b) it keeps us in business; and c) it goes both ways . . . if you're a neurologist with an epilepsy or MS patient who happens to get pregnant, are you going to manage her pregnancy? Heck no! Off she goes to the nearest OB doc!

Whoa, hold up, I am not stating that there is no role for neurologist. I was just pointing out that neurological issues to show themselves into other specialties. I was by no means trying to start a pissing match. Why must everybody on SDN try to start a pissing match over every comment?

 

[footcramp]

yes it is very depressing

 

[Bonobo]

A prominent pediatric neurosurgeon at my medical school mentioned to me that neurosurgery (particular pediatric neurosurgery!) is about the most depressing field one can practice. 95% of the time, he said, you either do little or occasionaly even make matters worse for patients who will suffer with disability for the rest of their lives. But then he grinned and said that it was the 5% of miraculous cases where he got to play a big part that made it all tremendously worth it.

In neurology, aside from epilepsy, migraine, certain autoimmune neuromuscular diseases, and dystonias, let's face it: neurology is more of a supportive specailty than anything else. It's not fair to compare it to medicine where cures are far more commonplace, and they have mastered primary prevention. Certainly, neurology is developing the potential for primary prevention of stroke, but that is still years away.

So yes, neurology as it is currently can be very depressing. But what drives many neurologists are the 'miraculous' cases. The cases where the patient whose diagnosis had alluded 5 other doctors before finally being diagnosed correctly by a neurologist leading to the proper curative treatment (e.g. antiobiotics, steroids, whatever). Or the cases in the neuroICU where coiling of an aneurysm, proper ICP management and monitoring of vasospasm allows one with an SAH to return to life. And of course, there is now tPA where the NNT is 8, and the NNH is shrinking to 20 and hopefully even smaller with some new adjunctive treatments and diagnostic methods coming on board.

During medical school, my dad urged me to choose a field where one could have an immense effect on a few patients lives--neurology allows this and makes the wait for all of the upcoming research worth it. And when it comes to migraines and dystonias, neurology is very successful.

The pendulum is swinging.

B