29 March 2009

Diagnose and Adios...

Random person: What kind of doctor are you?
Neurondoc: I am a neurologist.
RP: What is a neurologist? Are you a brain surgeon?
Me: Umm, no, I don't get my hands dirty and I don't perform surgery.
RP: You're not a brain surgeon?
Me (slightly annoyed): No.
RP: So what does a neurologist do, if they can't do surgery?
Me: I treat patients with neurological diseases.
RP: Ah.... How?
Me (grrrr): With medications and therapies and sometimes referrals for surgery.

That is a not uncommon exchange between me and some random curious person, regarding my medical specialty. Unfortunately, many medical students and physicians exhibit a similar attitude, which is characterized as "diagnose and adios". There are many neurological diseases and disorders that do not have treatments, so many medical professionals consider it a frutiless specialty -- we can diagnose the patients, but we can't do a thing for them. It is a highly annoying attitude that pervades medicine in general. When I decided to go into neurology during my 3rd year of med school, I got one of several reactions ("Why?" "Yuck!" "Better you than me." "Diagnose and adios..." "You can't do anything for the patient, why do you want to go into neurology?" etc). Sort of like Bones McCoy's attitude to 20th century medicine in Start Trek IV, but even more annoying.

The brain absolutely fascinates me, nerves to a lesser degree. The brain is the organ that all other organs exist to support and live to serve. The heart pumps blood to the brain -- percent blood flow from heart to brain is 15-20%. The lungs oxygenate blood to provide the brain with oxygen, and the brain uses about 20% of total resting oxygen.* The gut absorbs nutrients so that the brain gets fed. The liver and kidney clean the blood of toxins and other crap, so that the brain remains healthy and isn't poisoned in situ. The eyes provide visual information for the brain to process; the ears allow for auditory recording. The legs move the body around so that the brain has new things to experience or to avoid dangerous situations. I am "brain-o-centric", okay?

However, I do have to agree that neurology is fraught with progressive, degenerative and untreatable conditions: e.g., Huntington's Disease, Alzheimer's diease, Lou Gehrig's Disease (ALS), Muscular Dystrophy, traumatic brain injury, spinal cord injury. Even the "treatable" ones are not usually curable: Multiple Sclerosis, Stroke, Parkinson's Disease, Epilepsy. So why am I a neurologist? As I said, the brain is totally cool and interesting. Knowledge in medicine is ever-expanding, and we are learning more and more about the underlying workings of the brain, spinal cord and nerves, and also about the diseases that affect the nervous system.

Perhaps, Pinky and the Brain express their love of the nervous system better than I ever could...



Fun website for silly brain and other nervous system facts is Brain Facts and Figures


* Kandel et al., Principles of Neural Science, New York: McGraw Hill, 2000 (<--- look a footnote!)

8 comments:

Jeri said...

I love Pinky and the Brain. My dogs are all Pinkies. ;)

neurondoc said...

I had never heard of Pinky and the Brain until a coworker emailed me a link to this video. Of course, she emailed it right after I finished giving a neuroanatomy lecture. If I had known about it beforehand, I would've started my lecture with this video. :-) And I have since watched a whole bunch. ThePinkThing isn't quite ready for Pinky, yet...

Ilya said...

There are "brain surgeons", though, aren't there? What do they deal with that a neurologist does not?

vince said...

I think the brain is fascinating as well, and although many many neurological diseases and disorders have no treatment, much less a cure, much research is being done and that won't always be true.

If I had a neurological problem, I'd at least want to know exactly what I had and my prognosis, so specialists like you are very important, in my opinion.

And I love Pinky and The Brain!

neurondoc said...

Ilya -- yes, there are brain surgeons (neurosurgeons). They deal with neurological issues that require surgery to fix: tumors, some types of hemorrhages, vascular malformations, aneurysms, etc. I will never denigrate neurosurgeons -- they can do amazing things. However, it is a very good thing that I am not one, as I do not have the steadiest of hands...

xinef said...

Love Pinky and the Brain. We bought a "Best of" DVD set several years ago. Something like 5 or 6 CDs. Includes the wonderful Christmas special, and the "Brain" clip that you posted. Those shows were wasted on kids! :)

Christine

John the Scientist said...

Your time is coming, ND. 15 years ago, Rheumatologists were in the same position you were. Then Enbrel came along. We know less about brain function than immune function, but in another 15 years, you're going to have some tools to work with.

Tom said...

Diagnosis is important, even if the condition can't be treated. At least now you know it isn't something else, the treatment for which might be harmful to a patient erroneously thought to have the "something else."

Knowing what's really wrong is the ultimate "rule out."