general neurology

5 patients. One attending. One resident.

I shadowed a neurologist attending, more so a buddy from an adjacent lab, at the general neurology clinic in the Ambulatory Care Center last Thursday, July 28th, from about 1:30 to 4:30.

It seemed more relaxed that I had previously thought. The physicians actually were able to spend 30 minutes to 1 hour for each patient, which was nice in itself, being able to engage in conversation with the patient over their life/history. Human history is interesting to me- this probably connects with my fascination with life and death again.

I want to know how people live their lives. What makes people want to live, and what decisions do people make in order to make themselves happy? Why do bad things happen to good people? Why is the body so frail, and why does our corporeal form revolt?

Sometimes it's also fun to live vicariously through patients, since it's near impossible to do everything we want to do in this one life given to us. You get a chance to see with each patient what it might have been like to be a long-distance runner, a grandmother of 8, or playing chair volleyball at the retirement home.

What did I learn...

Patient history is, obviously, extremely important, although I think they call this PMH now. Past medical history, which in itself is sort of redundant, so I don't understand the reasoning for that nomenclature. Being able to focus during a patient's conversation while sifting for relevant information is another useful tool to possess.

Once that history is taken, the physical exam is also crucial. I saw my attending friend suggest some techniques that she could have used to diagnose neurological deficits. (Totally forgot the names here, but probably not important for me until later on...)

Now that both parts are complete, it was time to go through all the data, pick out which symptoms were more important to treat first, and then deliver a diagnosis and treatment plan. As neurologists, they first needed to decide whether this patient's case was a neurological problem. If not, they would either recommend that the patient's PCP do additional testing before going back to them, or they would tell the patient not to worry unless their incident occurred again.

However, if it were a neurological issue, the doctors tried to identify the cause of their illness. Which disease, or condition, would result in or best explain all the symptoms seen? At this point, it really seemed like the show House, involving differential diagnosis.

Next time, I think I'll get the chance to shadow her in an ALS clinic, which I'm told may be rather tragic, since confirmation of ALS spells out death basically for the patient. If it's ALS, it's always bad news to break to the people involved. I still want to see this though, for myself. How do other people react to bad news, especially when it concerns the rest of their life?

I thoroughly enjoyed this experience, I would say. This hasn't changed my mind about wanting to pursue a neuro-specific field, but I'm still uncertain about neurosurgery versus neurology.