why neuro isnt popular

[anxietypeaker]

hey, college student here. Just was speaking with IM residents that are planning to do ID fellowships. ALL of them mentioned that nervous system is incredibly fascinating along with the mechanism of disease... but they wouldnt do it for 2 reasons:

1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology.

2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?

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[neurologist]

hey, college student here. Just was speaking with IM residents that are planning to do ID fellowships. ALL of them mentioned that nervous system is incredibly fascinating along with the mechanism of disease... but they wouldnt do it for 2 reasons:

1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology.

2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?

I don't understand this whole "neuro isn't popular" stuff. Neurology is plenty popular with people who like neurology, so who cares if cardiology or orthopedic-surgeon-wannabes don't like it? If you polled me, I'd say ID is pretty unpopular -- bug . . . drug . . . bug . . . drug . . . what's so exciting about that? (not to mention that it's one of the few specialties that pays lower than neuro )

As for other specialties "doing a lot of neuro," well, there are a lot of conditions with overlap, for example, obstructive sleep apnea. Basically, it's a problem with upper airway anatomy. It's largely diagnosed using neurophysiologic tools (polysomnogram), and treated with CPAP (pulmonary toy) or by surgery (so, maybe it's really an ENT illness . . ). But in the broad area of "sleep disorders," OSA is only one of many, the rest of which ENT or pulmonary have not a clue what to do with, hence the need for neuro.

As for IM doing neuro, in my experience that is a joke. IM hands off neuro patients to neurology with clear intent of never dealing with them again. As for pain going to anesthesia/physiatry, well, they are welcome to it!

 

[Nerdoscience]

"1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology."

Stroke patients can often be cured better than HIV or Hepatitis C patients. Not always, though. It is definitely true that there are many uncurable Neuro diseases, but most are treatable. I would say that it is actually comparable to Internal Medicine. Think about Hypertension, for example. Almost never cured, but often successfully treated.

"2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?"

ID: Often does go to ID or Gen Med. Not always
Sleep: Depends on the area. In some markets, it's all pulmonary. This really makes no sense, as there is only one pulm sleep disorder (OSA), and the rest are Psych and or Neuro. In other markets, it's all IM/Psych or Neuro.
Pain: Goes almost exclusively to anesthesia, with a few physiatrists and Neurologist mixed in. Most Neurologists have no problem with that at all. Pain is an aptly named specialty
Alzheimer's: Mostly Psych and Neuro. Some easy cases are managed by Medicine.

In other words, there is a lot of overlap, but there are a lot of areas where is NO overlap, and it doesn't really matter if there is, as there is always a market available where you CAN do those things.

 

[GopherBrain]

Pain is an aptly named specialty

The wisest words to grace this board in a long time...

 

[drusso]

The wisest words to grace this board in a long time...

As a physiatry-trained pain specialist I can tell you that pain is fascinating from a neurological point of view. What we're beginning to understand about the spinal and supra-spinal modulation of pain, the neuorochemistry of cytokines and their role in modulating pain (ie thalidomide-derived drugs for complex regional pain syndrome, etc), and even the genetics of nociception makes for an interesting specialty; not to mention the whole "mind-body" dimension.

The field of pain medicine really lacks interested and motivated neurologists. I think this because it is mostly symptomatically-oriented treatment and neurologists tended to stay away from the field. It's also more difficult to neurologists to get the procedural training in their residencies (axial spine procedures, spinal cord stimulators, implantable pumps, etc) that would make them competitive applicants for fellowships. Physiatry and anesthesiology residencies incorporate these experiences more than neurology does. The neurologists I know who get interested in pain usually end-up doing headache fellowships which makes sense I suppose...

 

[neurologist]

As a physiatry-trained pain specialist I can tell you that pain is fascinating from a neurological point of view. What we're beginning to understand about the spinal and supra-spinal modulation of pain, the neuorochemistry of cytokines and their role in modulating pain (ie thalidomide-derived drugs for complex regional pain syndrome, etc), and even the genetics of nociception makes for an interesting specialty; not to mention the whole "mind-body" dimension.

The field of pain medicine really lacks interested and motivated neurologists. I think this because it is mostly symptomatically-oriented treatment and neurologists tended to stay away from the field. It's also more difficult to neurologists to get the procedural training in their residencies (axial spine procedures, spinal cord stimulators, implantable pumps, etc) that would make them competitive applicants for fellowships. Physiatry and anesthesiology residencies incorporate these experiences more than neurology does. The neurologists I know who get interested in pain usually end-up doing headache fellowships which makes sense I suppose...

Well, yeah, sure it's interesting from a pathophys point of view. Unfortunately, you still have to take care of patients and let's be honest, many if not most of them are extremely high maintenance people who expect nothing short of miracles, and we ain't got those.

What the field of pain medicine really lacks is interested and motivated patients who are willing to recognize that many pain syndromes a) are not curable but b) are not fatal and can be modulated by lifestyle and attitude changes. Unfortunately, this insight is often lacking and everyone wants to fall back on some magic high tech or pharmacologic fix. THAT's why so many docs don't like dealing with pain.

And please don't tell me how wonderful physiatry and gas are doing with all their injections, pumps, etc. I've see countless patients who've either failed those or come back and said "they told me there's nothing they can do for me."

 

[Onco]

hey, college student here. Just was speaking with IM residents that are planning to do ID fellowships. ALL of them mentioned that nervous system is incredibly fascinating along with the mechanism of disease... but they wouldnt do it for 2 reasons:

1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology.

2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?

Well you are quite right. The problems with Neurology are similar to Psychiatry. You are right in that many other specialities have a hand in Neuro that takes away from the importance of Neurologist. The boundaries of the field are still vague with many cases still being dealt by Psychiatrists. E.g. Dementia is not clear cut Neurology and so on. Therapeutics are non-existent and funding for research is difficult. Neurosurgeons have better oppurtunities, in the cming decades, to invasively look for and find cures for many Neurological diseases.

Agreed the world is waiting for cure of Parkinson but before Parkinson, the world needs cure for RA, Diabetes, HTN, Glomerulonephritis as they are a 100 times more common than PD. Add to it the fact that there is a certain charisma/power associated with being a 'Doctor's Doctor'.. i.e. the Internists. Neurologists can only opine on very selected patient population that even gets more shrinked due to emphasis of subspecialities..

Hope that helps..

 

[Jennifer626]

Well you are quite right. The problems with Neurology are similar to Psychiatry. You are right in that many other specialities have a hand in Neuro that takes away from the importance of Neurologist. The boundaries of the field are still vague with many cases still being dealt by Psychiatrists. E.g. Dementia is not clear cut Neurology and so on. Therapeutics are non-existent and funding for research is difficult. Neurosurgeons have better oppurtunities, in the cming decades, to invasively look for and find cures for many Neurological diseases.

Agreed the world is waiting for cure of Parkinson but before Parkinson, the world needs cure for RA, Diabetes, HTN, Glomerulonephritis as they are a 100 times more common than PD. Add to it the fact that there is a certain charisma/power associated with being a 'Doctor's Doctor'.. i.e. the Internists. Neurologists can only opine on very selected patient population that even gets more shrinked due to emphasis of subspecialities..

Hope that helps..

This is a very one sided view of neurology from someone who does not know what they are talking about. I was laughing so hard when I read this I almost fell off my chair.

There are many many diseases/conditions which are clear cut neurology: (ie. Epilepsy, Movement Disorders, Neuroimmunology, Headache etc.) Sure many fields have a hand in interventional neuro (rads, neuro, neurosurg) & neuromuscular (neuro & PM&R). Neurologists are still first line for stroke patients...I haven't seen a neurosurgeon who wants to come down to the ER to do a neurologic exam/ workup or give TPA. And of course psychiatrists and neurologists handle dementia/alzheimer's patients, but that is because of the overlap of Behavioral Neurology & Psychiatry which is a small subset of Neuro. There are enough dementia patients to go around...believe me....i think it's wonderful that psych and neuro take care of them. Otherwise there may not be enough docs to care for them.

Neurologists have such a wide variety of patients they see. There is actually a huge shortage of neurologists in the country right now...this field is not going anywhere and the patients they treat are not being taken away by other fields. Neurologists are in high demand.

Saying that neurosurgeons are going to be the only ones to figure out cures for current neurologic disease makes me laugh even harder. Neurosurgeons are amazing and do wonderful work in terms of treatment as far as Deep Brain Stimulators for PD as one example....but Neurologists are still the ones who dx, treat with medications, and when the medications no longer work the patient is reffered to the neurosurgeon for the DBS...and then back to the neurologist to manage.

There are an amazing number of breakthroughs in treating/curing neurologic disease right now. Most neurologists are very academic and thus very research oriented & will continue to discover new treatments/cures. I'm sorry but it WILL NOT be just the neurosurgeons "invaisively" looking for cures...as there are many neurologic conditions that can't be treated invasively & as I said neurologists are constantly reasearching and making breakthroughs!!!!

And please the old gripe of neurologists don't treat anything simply isn't true anymore...maybe you should read more or do a neuro rotation. Go look at the ischemic stroke patient who received TPA and now has no deficits, the PD patient who is controlled on levodopa or DBS, the 25 yr old MS patient whose disease is haulted by interferons, and even the patient with seizures who is seizure free due to antiepileptic drugs, or if not controlled by drugs... brain mapping (done by neurologists) prior to neurosurgery to remove the seizure focus.

"Therapeutics are non existent and funding is difficult" I'm sorry but that is dead wrong. There are drugs for everything, sure they may not be cures...but internists don't necessarily have those for everything either. Funding is everywhere! Read any neurologic journal, check out any neurology department website...funding is everywhere & neuro is a hot field for reasearch funding right now!

And lastly....please never say that the world needs a cure of DM, etc. before Parkinsons....the world just needs good doctors and the discovery of cures for all diseases. Don't belittle another disease...all of these patients have life altering conditions and need help...not one more than the other.

All of medicine is about collaboration with other specialties...which is a great thing. I never understand why other people have to knock other specialties...its all about what you like, but believe me in any field there will be multiple types of docs who invade your territory. Remember that this is all for the benefit of the patient and your job isn't at stake because some other fields treats those types of patients too. Everyone brings something unique to the table.

 

[Cephalorectus]

Well you are quite right. The problems with Neurology are similar to Psychiatry. You are right in that many other specialities have a hand in Neuro that takes away from the importance of Neurologist. The boundaries of the field are still vague with many cases still being dealt by Psychiatrists. E.g. Dementia is not clear cut Neurology and so on. Therapeutics are non-existent and funding for research is difficult. Neurosurgeons have better oppurtunities, in the cming decades, to invasively look for and find cures for many Neurological diseases.

Agreed the world is waiting for cure of Parkinson but before Parkinson, the world needs cure for RA, Diabetes, HTN, Glomerulonephritis as they are a 100 times more common than PD. Add to it the fact that there is a certain charisma/power associated with being a 'Doctor's Doctor'.. i.e. the Internists. Neurologists can only opine on very selected patient population that even gets more shrinked due to emphasis of subspecialities..

Hope that helps..

All hail the return of Onco--the most ignorant poster on SDN!!!

 

[salmonella]

Well you are quite right. The problems with Neurology are similar to Psychiatry. You are right in that many other specialities have a hand in Neuro that takes away from the importance of Neurologist. The boundaries of the field are still vague with many cases still being dealt by Psychiatrists. E.g. Dementia is not clear cut Neurology and so on. Therapeutics are non-existent and funding for research is difficult. Neurosurgeons have better oppurtunities, in the cming decades, to invasively look for and find cures for many Neurological diseases.

Agreed the world is waiting for cure of Parkinson but before Parkinson, the world needs cure for RA, Diabetes, HTN, Glomerulonephritis as they are a 100 times more common than PD. Add to it the fact that there is a certain charisma/power associated with being a 'Doctor's Doctor'.. i.e. the Internists. Neurologists can only opine on very selected patient population that even gets more shrinked due to emphasis of subspecialities..

Hope that helps..

I used to think "doctor's doctor" refers to pathologists and radiologists, or subspecialists, as opposed to general internist.

 

[GopherBrain]

I used to think "doctor's doctor" refers to pathologists and radiologists, or subspecialists, as opposed to general internist.

You used to think that because pathologists and (to a lesser extent) radiologists are the classic "doctor's doctors". Your use of the phrase is correct. The alternate use, for internists, is much less commonly applied.

 

[llogg]

hey, college student here. Just was speaking with IM residents that are planning to do ID fellowships. ALL of them mentioned that nervous system is incredibly fascinating along with the mechanism of disease... but they wouldnt do it for 2 reasons:

1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology.

2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?

I'm going to ignore the troll for once and just speak to the original poster.
1) ID is a poor example to draw from in comparison to neuro in terms of "curing patients" as ID is the subspecialty of internal medicine that deals with the one area of medicine that can routinely be cured without surgery: infection. Antibiotics are basically the only IM tools that cure anything. So of course ID specialists are going to feel they have more opportunities to cure. Comparing general neuro to general medicine and the differences are not nearly so stark.
2) Infectious processes involving the nervous system will often involve ID specialists, but often only after a neurologist has worked the patient up for the presenting neurologic complaints. Patients don't come in complaining of neurocysticercosis. They complain of weakness, dizziness, paresthesias, etc and the neurologist figures out why. If it's an infection they will then consider consulting ID. Just like they would consult a neurosurgeon or heme/onc if that were appropriate.
3) I would expect neuro to care directly for AD more than IM, but IM docs will see a lot of AD pts as they tend to have multiple comorbidities. Psych may see AD more than either IM or neuro.

Finally, you may ignore everything I've typed above, but I beg of you to take this to heart: Onco is a troll whose knowledge of neuro wouldn't require the firing of two neurons to recall it and he/she should be utterly ignored.

 

[Unsure Person]

Everyone carry along with this professional conversation with the mature thoughts being exchanged. Everyone except for the most widely despised, idiotic, clueless, and immature poster on SDN: Onco. When is this person going to get a life and realize he/she is a nuisance to SDN and the whole wide word? Where is the almighty IGNORE button I search for?

 

[Onco]

Salmonella,

I think GopherBrain explained it perfectly

To other not-so-sure trolls.. I am not trying to downplay Nurologists. I suspect most neurologists are unwilling to realistically look at the problems faced by their speciality. I dont think thats the case with other specialities of medicine which are open to constructive criticism. Neurologists need to open up a bit.. Most of them seem like freudian philosophers who are holed up in their thoughts as if the external world doesnt exist. They need to find therapeutic interventions and help their patient population. Learn from the Neurosurgeons!

 

[neurologist]

Salmonella,

Learn from the Neurosurgeons!

OK, here's what I've learned from neurosurgeons so far in my career:

#1. If the NEUROLOGIST sends me a patient who he has evaluated and found a tumor, I can spend a couple hours in the OR debulking it. I will see the patient back once for a post-op follow up and otherwise they will follow up with NEUROLOGY, rad onc and med onc, If the tumor was a high grade astro (which is the most common adult tumor, BTW) the patient will be dead in a year anyway no matter how much I whack out.

#2. If the NEUROLOGIST sends me a patient who has had evaluation including imaging and video-EEG demonstrating lesional epilepsy, I can take out the lesion. If the lesion is possibly near eloquent cortex, I will have the NEUROLOGIST do intra- or inter-operative brain mapping to demarcate the areas I shouldn't touch. I will see the patient once for post-op followup, otherwise they will follow up with NEUROLOGY.

#3. If the NEUROLOGIST sends me a patient with medically refractory nonlesional epilepsy, I can spend a couple of minutes in the OR putting in a VNS. I will see them once for post-op follow up, and their VNS will be managed by a NEUROLOGIST.

#4. If the NEUROLOGIST sends me a patient who has been diagnosed with Parkinsons and failed meds, I can spend a couple of hours in the OR putting wires into their thalamus, while a NEUROLOGIST conducts serial exams to make sure we're stimulating the correct subnucleus. Because they have hardware in their head, maybe I will see them once a year, but the device will otherwise be managed by a NEUROLOGIST.


#5. If the NEUROLOGIST sends me a patient with intractible back pain, and an EMG done by a NEUROLOGIST demonstrating a lumbar radiculopathy, I will say "sorry, there's nothing I can do for you; follow up with your neurologist for your chronic pain problem."

Yup, we sure can learn a lot from those smart neurosurgeons!!!!!!

 

[llogg]

Salmonella,

I think GopherBrain explained it perfectly

To other not-so-sure trolls.. I am not trying to downplay Nurologists.

Yes, that is exactly what you are trying to do. What you are succeeding in doing is showing what a fool and troll you are.

I suspect most neurologists are unwilling to realistically look at the problems faced by their speciality. I dont think thats the case with other specialities of medicine which are open to constructive criticism.

You are a fourth year medical student who fails to comprehend the profound limitations of his experience and the fallacy of applying that miniscule experience to generalizations about entire fields of medicine.

Neurologists need to open up a bit.. Most of them seem like freudian philosophers who are holed up in their thoughts as if the external world doesnt exist. They need to find therapeutic interventions and help their patient population. Learn from the Neurosurgeons!

How many neurologists do you even know? Three, five, maybe a dozen? And you are willing to draw conclusions about most neurologists and their philosophical bent? Congratulations, you sir, have the logical reasoning capacity of a three-year-old.

 

[bjolly]

Add to it the fact that there is a certain charisma/power associated with being a 'Doctor's Doctor'.. i.e. the Internists.

oh absolutely. Charisma and power are the first things that come to anyone's mind when you mention internists. Cause, you know, that's the big glamour job in medicine.

 

[Onco]

OK, here's what I've learned from neurosurgeons so far in my career:

#1. If the NEUROLOGIST sends me a patient who he has evaluated and found a tumor, I can spend a couple hours in the OR debulking it. I will see the patient back once for a post-op follow up and otherwise they will follow up with NEUROLOGY, rad onc and med onc, If the tumor was a high grade astro (which is the most common adult tumor, BTW) the patient will be dead in a year anyway no matter how much I whack out.

#2. If the NEUROLOGIST sends me a patient who has had evaluation including imaging and video-EEG demonstrating lesional epilepsy, I can take out the lesion. If the lesion is possibly near eloquent cortex, I will have the NEUROLOGIST do intra- or inter-operative brain mapping to demarcate the areas I shouldn't touch. I will see the patient once for post-op followup, otherwise they will follow up with NEUROLOGY.

#3. If the NEUROLOGIST sends me a patient with medically refractory nonlesional epilepsy, I can spend a couple of minutes in the OR putting in a VNS. I will see them once for post-op follow up, and their VNS will be managed by a NEUROLOGIST.

#4. If the NEUROLOGIST sends me a patient who has been diagnosed with Parkinsons and failed meds, I can spend a couple of hours in the OR putting wires into their thalamus, while a NEUROLOGIST conducts serial exams to make sure we're stimulating the correct subnucleus. Because they have hardware in their head, maybe I will see them once a year, but the device will otherwise be managed by a NEUROLOGIST.


#5. If the NEUROLOGIST sends me a patient with intractible back pain, and an EMG done by a NEUROLOGIST demonstrating a lumbar radiculopathy, I will say "sorry, there's nothing I can do for you; follow up with your neurologist for your chronic pain problem."

Yup, we sure can learn a lot from those smart neurosurgeons!!!!!!

Thats one of the good posts that I've read on this forum

cheers..

 

[salmonella]

oh absolutely. Charisma and power are the first things that come to anyone's mind when you mention internists. Cause, you know, that's the big glamour job in medicine.

So do you think neurology is more glamorous than internal medicine? Do neurologists receive more respect (from patients and other medical/surgical specialties) than internal medicine subspecialists?

 

[danielmd06]

Respect is given to individuals in my experience. I have very rarely seen it bestowed wholesale on select specialties within the hospital.

Anxiety, I think your concerns have largely been answered by previous posters with alternate points of view.

Enjoy college, work hard in medical school, and let your heart, mind, and experiences in your clinical rotations guide your career path.

Good luck.

 

[filter07]

The reason why many people don't like Neurology is because the clinical practice is very unsatisfying. There is nothing worse than the inpatient stroke service. A typical inpatient stroke patient comes in with some TIAs. The neurologists get a bunch of imaging studies such as a head CT, MRA, angio, carotid duplex. They prescribe some aspirin, plavix, or Aggrenox, maybe some statin for the long term. Meanwhile the patient continues to have TIAs. They consult the vascular surgeons, and they come by in a day or two. Meanwhile the patient has more TIAs. The vascular surgeons say they want another angiogram in the meantime. Another angiogram is ordered. Frustrated, the neurologist consults the interventional vascular neurosurgeon, who looks at the angiograms and deems the patient suitable for a intracranial vascular procedure. The patient gets taken to the angio suite where he has a stroke. Now the patient is unsuitable for the procedure. About three hours worth of debating over tPA ensues. By the time the debate is over, the window period for tPA is over and now all the neurologist can do is sit there and do serial neuro exams. For the next several days the neurologist does daily neuro exams with no clear purpose. The patient either goes home with a stroke and disability, or has another stroke, in which case the tPA debate begins again or the patient dies.

This is why people don't want to do Neurology.

For the record I think the brain is fascinating and Neuroscience is an amazing field. Neurology however is not my cup of tea.

I think most people who are interested in Neurology are primarily fascinated with the brain. The trouble is, not much can be done by a neurologist for brain problems. Most of the procedures and money makers are peripheral nerves, sleep studies, and other random things. If you want to inject things into peripheral nerves - if that's what interests you about Neurology, that's great. But if you're interested in the brain and treating its diseases, Neurology sucks. Stroke goes to vascular and neurosurgery. Epilepsy is either some blanket approach or for specific treatment it goes to neurosurgery. Brain tumors go to neurosurgery. Alzheimer's has either Aricept or Namenda, neither of which are that great. Parkinsons has unsatisfying treatments. Multiple sclerosis has no good treatment. Autism has no treatment. Most of the interesting things about Neurology have no good treatments; the good treatments are in peripheral nerves, neuromuscular stuff, and other random things which no one really likes.

Neurology is great if you want to be a researcher. It sucks if you want to be a clinician. But then again some people like sitting around and thinking about where the lesion is, while waiting for a bazillion imaging studies to be done.

 

[typhoonegator]

Never before have I read a comment that so succinctly illustrates a poster's idiocy.

I really hope no one takes the previous comment seriously. By the author's logic, no one should do anything that is hard, and no one should go into a field where you cannot cure every one of your patients.

I work frequently on a very large stroke service, and I have never experienced a scenario like the one filter07 describes above. It is quite tiresome when naysayers continually drag out the hackneyed comment that neurologists cannot treat anything. Brain tumors don't go to neurosurgery; we ask the neurosurgeons to take out tumors and then we treat the cancer. Cognitive neurology and behavioral neurology are burgeoning fields, and just because we can't treat AD effectively today doesn't mean we should give up or that attempting to modify disease progression isn't edifiying. Parkinson's Disease has extremely satisfying treatments, and the relationships you form with these long-term patients is wonderful. The assertion that MS has no good treatment is patently ludicrous. We can't cure AIDS either, does that mean no one should go into ID?

Actually, I'm just going to stop right there. The above poster has no idea what they are talking about. Anyone who deals with things in such black and white terms is either not intelligent enough or not open-minded enough to warrant any more of my time.

 

[angelpippygirl]

I find it so irritating when people say that neuro can't do anything for their pts. Can't fix them...blah blah blah...come in with a stroke...leave with a stroke...yadda yadda. Most medical things are "managed" anyways...such as DM, HTN, hyperlipidemia...most of the time you dont' cure those. We "manage" MS and movement disorders...seizure disorders. What's the difference? We do the best we can to help people and that's the point. I'm sure I could find a whole lot of negatives to say about whatever bull**** field filter07 is going into but I won't because people do whatever floats their boat. Its just sad how ignorant people are. They have ignorant opinions that unfortunately they have a right to express.

 

[danielmd06]

1) neuro is too much diagnosis and too little curing. One said that ID allows you to see interesting cases and oftentimes cure them. I brought up the fact that HIV patients cant be cured just like stroke victims. They conceded but they said that theres still a HUGE discrepancy on how many conditions ID can CURE as opposed to neurology.

2) They also said that other specialties do a lot of neuro. for example, an ID of the nervous system would more OFTEN go to ID people, sleep disorders OFTEN to pulmonary docs, pain OFTEN to physiatrists/anesthes.

Are these true? And also, say theres a patient with alzheimers...whats more TYPICAL, a neuro taking care of him/her or a IM taking care of him/her (or is it 50/50)?

My opinion:

1) This is a very weak reason. You can utilize that same argument about practically every single medical subspecialty. Ever read House of God? One of the tongue-in-cheek lines was "The only way to cure is with cold steel." You could argue all day long that surgeons and procedurally-oriented specialties are the only ones who "cure." Hypertension, diabetes, heart failure, upper respiratory infections...all are diagnosed and treated but not cured per se. Yet, I don't hear residents constantly remarking about how they hate IM because "they don't cure." This is ironically and consistently reserved for Neurology.

Of course there are treatments and cures for many Neurological issues. And the cures are certainly not handled exclusively be Neurosurgeons.

2) A good practicioner of medicine should be able to do alot of things IMHO. Examples? Read an EKG, read a chest x-ray, perform a complete neurologic exam, perform a complete visual and fundoscopic exam, perform a complete musculoskeletal exam et cetera. It's a strength, not a weakness, that practitioners of other specialties (including Neurologists) are capable of handling such issues.

Neurology is a perfectly accepted route to both Sleep and Pain medicine.

 

[neglect]

I really don't understand why someone would go to the neurology forum to rag on neuro. Is your life really so empty that you'd write 5 paragraphs about your idiotic opinions on a specialty that you don't like, much less know anything about?

Look, I actually like neurology. Not only do I like the clinical diagnostic end of things, but I also like treating people. Personally, I went into neurology for the neuroscience, but stayed for the neurology. In the past year I've given tPA to a 26 year old woman (and would like to think I saved at least a few million of her neurons for a long time to come), allowed an old woman with PD to cook her family a meal for the first time in a decade, and gave a lot of people headache free days. So I like it. I think there is a value when diagnosing incurable conditions, some fatal, most not. That's medicine. And in this regard, neurology favorably compares to any other medical specialty.

I wouldn't at all like being a surgeon, a rash doc, a radiologist, an OB, or a dentist. I actually don't know what rehab people do, and don't want to do that either. But I have no impulse to go on the psych forum and tell them how depressing I feel depression is. Instead, I think we all agree that a good psychiatrist is worth their weight in diamonds. Same with any good doctor: from dentist to proctologist and everthing between.

When you need one, your perspective changes drastically.

 

[Rocky2007]

This whole discussion seems stupid to me. One subspecialty doesn't trump another. We need neurologists, IM docs, radiologists etc. It's easy to hear second-hand from someone why you should or should not go into a specific subspeciality. The fact of the matter is that you need to experience each area of medicine for yourself and decide what interests you the most....and then...shock...you go into that specialty!

I also think it's ridiculous to say...oh there are no treatments in neurology...therefore I won't go into that field. Well at one time there was no treatment for HIV, DM, RA etc...now there are treatments (not cures), because somebody went into fields with big unsolved questions, did research, and saved some lives.

I decided to go into IM because it's what I enjoyed the most, other people decided to go into neuro for the same reason. Other people enjoy different things...moral of the story....do what you like. I doubt that people on this forum would be trashing neuro if they had some seizure problem or MS or some other hellish neuro disease.

 

[Nerdoscience]

I also think it's ridiculous to say...oh there are no treatments in neurology...therefore I won't go into that field. Well at one time there was no treatment for HIV, DM, RA etc...now there are treatments (not cures), because somebody went into fields with big unsolved questions, did research, and saved some lives.

Amen to the gist of what you said, but you make it sound like the above statement is true. 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.

But other than all those...

 

[Rocky2007]

I probably phrased my response wrong...I didn't mean that neuro has no "treatments"...I guess I meant there are a lot of unanswered questions...but that's that same with all subspecialties. I was just trying to make the point that if (hypothetically) a subspeciality didn't have many "treatment" options, it shouldn't stop someone from going into that field.

 

[Nerdoscience]

Just using your post as an excuse to release my rant.

 

[neuro-cocks]

thanks to all those who do not like neurology for their naive minds. treatment versus cure.
to the neurosurgeons who drain subdurals, there are still remains when it's complete.
to the ENTs who jab at sinuses, there is still the underlying cause untreated, to the internists trying to control blood sugars and blood pressures, it's all about control and not cure.
to the ID treating HIV, HIV will be there for life.
to the cardiologist stenting CAD, there's now a scaffold for restenosis.
to the surgeon performing the whipple, what cure was there?
to the radiologist reading that CT scan, what cure?
to the allergist, skin testing and benadryl did not actually "fix" the problem, only try to handle it.
to the pediatrician, charting those weights and heights and encouraging better practices makes one feel better but did not necessarily cure the lack of growth to this point.
treating neurologic conditions is like many others... we have little control over our genes. they will always have say in how our patients' lives begin the day. but did we choose to go into medicine only to say, "if i cannot cure this patient, i shouldn't even try?" i don't think so. it's frustrating to see people who hate neurology to come to a forum only to show their hate for the field. one day you will feel "i'm truly thankful someone loves neurology every day of their life." please read above. see the many conditions that can be treated and even some that can be cured. if that doesn't change your mind, please ease up. you will rarely see someone in neurology venturing to other fields' forums to bash their fields. it's medicine folks. it's all about the patients. it's not about the self-centered bashing of a field of medicine because you do not want to perform that type of care for the rest of your life. to those who love neurology, bless you.