What is a Neurologist?
Having lived and breathed neurology for the past decade or so, I forget that some people do not understand exactly what I do. Even here in the San Francisco Bay with a very highly educated population, I routinely get questions like “oh, so you don’t do surgery” or “what’s it like taking care of nut jobs all day”? But I can’t really complain because, for example, I have very little understanding of jobs in the computer industry. Work for Google?; great. Can I ask you any follow up questions other than “I hear you have a great cafeteria”?; no.
My short reply when asked what I do is, “if you know I’m not a neurosurgeon and not a psychiatrist, you’re in the right ballpark”. In the hospital, I may introduce myself as “the brain doctor”. In the office, sometimes I say “I’m the electrician for the body”. The official answer is I diagnose and medically treat neurological diseases. These diseases are rather broad include stroke, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, seizures, migraines, other headaches, pinched nerves, neuropathy, Bell’s palsy, myasthenia gravis, ALS, cervical dystonia, trigeminal neuralgia, vertigo, temporal arteritis, concussion, brain tumors, and multiple others. We work in the office, in the hospital, and very rare neurologists like me perform house calls. We are also the physician who would perform an EMG/NCV or read an EEG. While we typically review the MRI’s and CT scans we order, the scans are officially interpreted by a radiologist.
I would like to explain my short reply with two examples. I may diagnosis a brain tumor and send you to a neurosurgeon, but I won’t be doing the surgery. You may need to continue to see me if you develop seizures from the tumor and also we tend to do a lot of patient and family education. Separately, psychiatric conditions are very commonly associated with neurological conditions, but you would not see me purely for bipolar disorder, schizophrenia, or depression/anxiety without some neurological condition. As neurologists, we haven’t helped ourselves with this confusion very much. For example, a pediatric neurologist would treat ADHD in childhood and adolescence, but then as an adult you would see a psychiatrist. Historically, neurology and psychiatry are related which shows in my board certification that is from the American Board of Psychiatry and Neurology.
Medical management is treating symptoms with medicines and different therapies. For example, I may prescribe a medication to treat your migraines. We aren’t “pill pushers” though and it is not that uncommon to help certain conditions like dizziness by removing medications. A thorough review of your medications is part of our examination. We also prescribe physical therapy, acupuncture, occupational therapy, speech therapy, psychological counseling, etc.
Neurologists in particular have to treat patients who may have a disease that has no treatment. Medical advances are occurring but neurology is the last frontier. We are also the end of the line for medical mysteries. A lot of physicians feel that if everything else has been ruled out, it must be neurological. As such, we help patients and families through these difficult situations. Sometimes it is just reassurance that every horrible disease someone reads on the internet has been ruled out. It can also include giving a prognosis and also guidance of when someone needs more help at home or should be in an assisted living.
I hope after reading this article you may better understand what I do and why your primary care physician may have you see a neurologist. After all, April is Neurologist Awareness Month!
Michael Nelson MD is a board certified adult neurologist who performs house calls in the greater San Francisco Bay Area. He also is the CEO of Memento Care Home Network, which is an innovative company that certifies and networks care homes as the superior option for senior assisted living.