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Why Neurology?

Updated: Nov 16, 2020

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Samantha Fernandez Hernandez chose Neurology and why it is a great field.

When we are taught about the nervous system in med school, our immediate reaction is “OMG this is so complicated” and it quickly becomes one of our most dreaded subjects. When I think about the brain, I think of a small organ capable of reproducing the most odd and out-of-place symptoms, the most complex yet simple patterns that challenge us in deciphering the diagnosis, almost every time.

So Why Neurology? Because it challenges me every hour of every day.

Reasons to choose Neurology:

1. It requires an understanding of both the brain and the mind

One of my favorite things about Neurology is that we are also vastly trained in Psychiatry, and how could we not? The brain isn’t just responsible for language, movement, autonomic functions… it is responsible for our behaviors, our emotions, even our personalities and patterns. So if we want to understand the brain and nerves, we also need to understand the mind. Why was Mr. X going from hospital to hospital requesting treatment for MS, sharing how hard it was when he became paraplegic and even more challenging when his wheelchair broke and he had to drag himself everywhere… when the disease had been ruled out 10 year ago? By multiple specialists. Right now you are probably reading this and thinking “OK, it wasn’t MS, but it was something else, so what was the diagnosis?” The diagnosis? A personality disorder mixed with a rough and chaotic life, making him “need” the Multiple Sclerosis label. Now you’re probably saying “Why would anyone WANT to have a disease?” Simple. Because this disease that was in the process of being ruled out years back, gave him an identity. His childhood and early adulthood had been particularly rough, he felt like he didn’t have an identity. He didn’t know who he was or his purpose in this life, and when “We need to rule out MS” left those doctor’s lips 10 years ago, he finally had one: “The MS patient”. Mr. X thankfully wasn’t paraplegic. His extremities were strong. He could lay in bed, bend his legs and hold them up. And this tiny yet so important clue was revealed in the middle of a conversation/examination led by one of the most talented Neurologists I have ever worked with. Mr. X was so immersed in talking about what his life and struggles with MS was like, that he didn’t realize when the attending positioned his legs in a very particular way, that gave away the diagnosis…or lack thereof!.... Mr. X was not paraplegic. (And didn’t have MS!). Ask any paraplegic patient to hold their bent legs up while laying down in bed (Please don’t ask them!). They will think that you’re either cracking a joke or haven’t had a neuroscience course yet. How could anyone without motor function be able to have enough strength in their ATROPHIED, NON-FUNCTIONAL muscles, in order to hold their bent legs up? Which leads me to reason #2!

2. The diagnosis relies more on your clinical skills than on labs/imaging

A professor once told me: When you leave a patient’s room you must come out with 85% of your diagnosis made. And that is my mantra until this day. In Neurology, there is no more powerful diagnostic aid than the patient himself. Your clinical skills will help you differentiate a true seizure from a functional one, a cortical stroke from severe anxiety; the attention to detail and observational prowess a Neurologist requires can take some time to develop, but once you master the art, you will only need a CT scan or LP to confirm your diagnosis, not to come up with it.

3. You can do either inpatient or outpatient, depending on your lifestyle preference

One of the (many) beauties of Neurology is the flexibility it gives you when it comes to molding to your desired lifestyle. If you want a slower paced life, the outpatient setting is the one for you! From General Neurology to Multiple Sclerosis, from Headaches to Electrophysiology, you can enjoy the diagnostic challenges Neuro brings you, without having to sacrifice a great amount of your personal (and VERY important) life. Now, if you are like me and you crave that adrenaline rush the inpatient setting gives you, then life as a Neurointensivist or a Neurohospitalist might be the path for you! You will face acute neurological insults and acute neurological pathologies’ presentations, heightening the rush of the diagnostic challenge, because now it is time-sensitive x1000.

4. If you like research, the opportunities are ENDLESS!

Whoever said Neurology is a specialty with limited treatments and the inability to cure a patient, is probably the same person who started giving Docusate for constipation years ago. One of the things I love the most about Neurology is the endless research possibilities, how fast we are advancing, and that I get to be part of something bigger; not only do I have the privilege of studying and treating the nervous system, but I get to create new paths for future Neurologists. It wasn’t too long ago when we had only a handful of options to treat MS, and today we have over 20 disease modifying therapy agents. Just within the past couple years we found out that not only does ICP management in TBI patients impacts prognosis, but possibly PbO2 management does too. This has been a huge breakthrough for TBI treatment, as it is one of the most challenging conditions to manage, with no single successful treatment. So the next time somebody tells you that Neurology has very limited therapy options or poor neuropathophysiology knowledge, refer them to this point.

5. It makes you a more compassionate physician and human being

Being a physician, no matter the specialty, makes you a more compassionate person, but nothing has touched me or changed me more than seeing a person lose control of their body, their mind, their ability to function in daily life, and still keep the most positive of attitudes. When the middle age man suffering from NMO, whose life was turned upside down a month ago, tells me that he is grateful to wake up to his wife every day, even though he can no longer take her around the world due to his paraplegia, I appreciate life and family more than the day before… and as soon as I enter the next exam room, a new epiphany begins.

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