Worst parts of neurology?

[Robotneurologist]

I am currently debating between two different specialties to apply to in the fall. I've heard that the best advice for picking a specialty is to decide what the worst part of a specialty is and if you can stand that instead of thinking about what you like about the specialty. So SDNers who have lots of experience in the field what are considered the worst parts of neurology?

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[kchan99]

I am currently debating between two different specialties to apply to in the fall. I've heard that the best advice for picking a specialty is to decide what the worst part of a specialty is and if you can stand that instead of thinking about what you like about the specialty. So SDNers who have lots of experience in the field what are considered the worst parts of neurology?

This is a matter of personal opinion. There are aspects of each field that are appealing and unappealing. For example, a neurologist specializing in sleep medicine is unlikely to enjoy acute stroke management. What in neurology do you think you may enjoy? What areas of medicine bother you? What is the other specialty you are considering?

 

[TUGM]

I may just be experiencing burnout, but I can't stand rounding for 4-5 hours a day on altered mental status patients with pHs of 6.9.

I am more ICU/acute care oriented, and I get plenty of that experience and can stand to round 4-5 hours a day in ICU without too much issue.

 

[liquidshadow22]

If you don't love internal medicine, you probably will not love neurology. They are so similar. You need to love knowing every minutiae about your patients history, every detail about their neurological exam, mostly dealing with : AMS, Stroke, Seizure on the inpatient side (this will be primarily what you deal with during residency). For me the worst part of neuro is the patience of trying to get detailed histories from patient's that are often poor historians or because their mental status is poor cant give you any real history.

 

[NWwildcat2013]

If you don't love internal medicine, you probably will not love neurology. They are so similar. You need to love knowing every minutiae about your patients history, every detail about their neurological exam, mostly dealing with : AMS, Stroke, Seizure on the inpatient side (this will be primarily what you deal with during residency). For me the worst part of neuro is the patience of trying to get detailed histories from patient's that are often poor historians or because their mental status is poor cant give you any real history.

Really? I dont like IM as a whole because I don't like a lot of the bread and butter topics like GI and pulm (I do like rheum and heme), but I like neuro. I see neuro as IM minus a lot of the stuff I don't want to deal with.

 

[Gnocchi Monster]

Not entirely sure what liquid is talking about. Not every neuro resident "loves" IM by a long stretch. You should probably have an appreciation for IM as a lot of neurological disease is closely tied into it. Nothing persistently annoys me in neuro as I always find some learning points but here are a few possibilities: functional patients, routine stroke care, rounding with slow old school dinosaur attendings, ED resident lack of competence in neurology

 

[jd1031]

If you don't love internal medicine, you probably will not love neurology.

Yea definitely not true, at all. There's a big difference between liking the academic aspect of internal medicine and actually doing internal medicine work day in and day out. I like IM academically, and thinking about IM problems from the lens of a neurologist for me can be pretty fun. However, to answer the OP, the least enjoyable aspect of neurology (as a resident) is dealing with all the IM stuff in the trenches. Even heavy neuro consult service days are rewarding in comparison, since I have the chance to focus on neurology without being primarily responsible for IM work.

I see neuro as IM minus a lot of the stuff I don't want to deal with.

Yup. Well put.

It's hard form me to pin down the "worst" aspect of pure neurology, but, functional problems can be difficult to deal with. Even then, those can be very enjoyable and intriguing.

 

[kchan99]

It's hard form me to pin down the "worst" aspect of pure neurology, but, functional problems can be difficult to deal with. Even then, those can be very enjoyable and intriguing.

It's not that the functional disorders themselves that are difficult to handle once organic disorders have been appropriately ruled out, but it's the other issues, including personality disorders/traits, that make discussions difficult.

I can't say if neurology has more patients with functional disorders than other non-surgical specialties with patient contact on a regular basis. What I do know is that many of my pathology colleagues are in pathology specifically to avoid functional and personality disorders.

 

[Nonphysiologic]

I never liked how we spend hours on a patient encounter and exam and then offer very little.... like Alzheimer's for example. Also, it always annoyed me that we let other specialties can do aspects of our jobs for example: ER and stroke, Neurorads/Neurosx and interventional, NeuroICU and medical/surgical ICU, Neuroonc and medical onc/radonc/neurosx, EMG and PMR, Concussion and sports med. Also, a lot of times we give reccs on consult service on a patient with AMS or something and the primary (usually internal medicine) service tends to think we don't off much.

I know its cliche but sometimes I think there is a lot of thinking and time consuming thought process without a lot of action but to be honest that's actually what attracted me to neurology. I've always felt that diagnosis was the fun part of medicine and neurology is super logical. Also don't underestimate the therapeutic properties of having a diagnosis.

 

[Nonphysiologic]

I never liked how we spend hours on a patient encounter and exam and then offer very little.... like Alzheimer's for example. Also, it always annoyed me that we let other specialties can do aspects of our jobs for example: ER and stroke, Neurorads/Neurosx and interventional, NeuroICU and medical/surgical ICU, Neuroonc and medical onc/radonc/neurosx, EMG and PMR, Concussion and sports med. Also, a lot of times we give reccs on consult service on a patient with AMS or something and the primary (usually internal medicine) service tends to think we don't off much.

I know its cliche but sometimes I think there is a lot of thinking and time consuming thought process without a lot of action but to be honest that's actually what attracted me to neurology. I've always felt that diagnosis was the fun part of medicine and neurology is super logical. Also don't underestimate the therapeutic properties of having a diagnosis.

Oh also I should add... at least where I trained as much as the other services don't think neurology has to offer much they sure do love to consult the hell out of us

 

[NWwildcat2013]

I never liked how we spend hours on a patient encounter and exam and then offer very little.... like Alzheimer's for example. Also, it always annoyed me that we let other specialties can do aspects of our jobs for example: ER and stroke, Neurorads/Neurosx and interventional, NeuroICU and medical/surgical ICU, Neuroonc and medical onc/radonc/neurosx, EMG and PMR, Concussion and sports med. Also, a lot of times we give reccs on consult service on a patient with AMS or something and the primary (usually internal medicine) service tends to think we don't off much.

I know its cliche but sometimes I think there is a lot of thinking and time consuming thought process without a lot of action but to be honest that's actually what attracted me to neurology. I've always felt that diagnosis was the fun part of medicine and neurology is super logical. Also don't underestimate the therapeutic properties of having a diagnosis.

This aspect of other specialties doing stuff that neuro does really concerns me. Is it something I should be concerned about with regard to career prospects?


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[Nonphysiologic]

No just do what keeps you intellectually curious. Epilepsy and movement are still pretty neuro specific still and are impactful fields. Pain is great too but it's traditionally given to anesthesia


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[kchan99]

For pain, PM&R is another consideration. PM&R is more procedural than neurology: ultrasound guided injections, EMGs, botulinum toxin injections for spasticity, etc.

 

[liquidshadow22]

What is the difference between managing Chest pain/ Shortness of breath/ Cough vs (Headache, Dizziness, numbness, Back pain)? Not much. The process is pretty much the same. You get a detailed history, examine the patient, order some tests, then prescribe a medication. The way IM is practiced is very similar to the way Neurology is practiced. The only big difference is you get to routinely look at neuroimaging which is cool, and occasionally perform an LP in neurology. Yes learning about neurological illness is interesting but the day to day operations of an internist are much akin to a neurologist.

 

[kchan99]

The process is pretty much the same. You get a detailed history, examine the patient, order some tests, then prescribe a medication. The way IM is practiced is very similar to the way Neurology is practiced. The only big difference is you get to routinely look at neuroimaging which is cool, and occasionally perform an LP in neurology.

I suppose that the thought process can be somewhat different in neurology with neurologic localization, but other things, such as determining etiology, e.g. vascular, toxic, infectious, etc. are similar to internal medicine.

 

[Thama]

This aspect of other specialties doing stuff that neuro does really concerns me. Is it something I should be concerned about with regard to career prospects?


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No. Other specialties for the most part regard the brain as a black box and steer as far away from it as they possibly can. This is excepting psychiatry, who regard it as an object of a sort of Zoroastrian ritual, and neurosurgery, who regard it as a bundle of cables to avoid cutting if possible.