Neurology

Another rotation down!

Let me first explain the breakdown of the neurology rotation. We spend a month on the service but it is divided into thirds: wards, consults and clinics. The reason for this being that each service sees very different kinds of neurological cases. On wards, one is likely to see a lot of patients with strokes or epilepsy. Consults is more of the same with some oddballs added to the mix. A patient on, say, the cardiology service might suddenly develop leg weakness and the Neuro consult service would be called on to evaluate the patient's new problem, though their primary reason for being in the hospital is not a neurological issue. On the clinic service, anything is fair game. Headaches, Parkinson's, Alzheimer's, Epilepsy, Stroke follow-ups, Multiple Sclerosis and a variety of movement disorders.

Disclaimer: This blog has become my primary place to record my impressions on a given field to help guide my future career decisions. These are only my personal opinions based on a very limited exposure and are therefore not meant to dissuade anyone from entering a given field, or to detract from any department at this institution.

The pros and cons of Neurology as I see it:

Pros:

• The neurology residents were top notch. Nerdy-cool, well-adjusted, friendly and they seem to love to teach!
• Procedures: I helped perform 2 lumbar punctures (you may know them as spinal taps) and learned to place nerve blocks for people suffering from certain types of headaches
• The physical exam in neurology is extremely detailed and it's pretty fun to try and localize the lesion (be it a stroke, tumor, abscess or a peripheral nerve problem) within the nervous system based on your exam findings.

Cons:

• Lengthy and expensive work-ups (especially for strokes) with seemingly little knowledge gained or benefit to the patient
• Very few diseases in Neurology have cures; treatments are symptomatic or merely intended to slow disease progression
• Neurological diseases are devastating. It's heartbreaking to see patients with disabling movement or speech disorders, especially when they are entirely cognizant of their deficits.

One thing I am starting to learn about myself is that I love instant gratification! I like to see a patient, diagnose the problem, provide some sort of intervention, and see some immediate improvement in the patient's condition. I guess I am just simple minded like that. It's just funny because I used to think I would enjoy spending a lot of time educating patients and trying to help them modify risk factors for disease. Perhaps my ideal career will combine an intervention with some long-term/preventative care.