Post-Neurology Rotation Update: Clinic (Week 4)

On the last week of the rotation, I spent a few half-days in various clinics. I like that we were allowed a “whirlwind tour” of many types of clinic environments instead of being assigned to a single location for the week. I spent a half-day each in peds neuro, adult epilepsy, and adult neuro clinics, and I also shadowed in peds neuroradiology and EMG/neurodiagnostics.

Peds neuro was probably my favorite clinic. It was very hands-on; I saw patients alone, presented to the attending, and then accompanied the attending as he saw the patient afterward. Many diagnoses are represented by the peds clinic–migraines, epilepsy, Tourette’s, developmental delay, etc. The interesting thing about the management of some of these conditions is the overlap between neurology and psychiatry. On more than one occasion, I witnessed an attending discuss the relationship between emotions and behavior with a patient and caregiver; for example, parents were told that stress of various kinds may make tics worse, or a frustrating situation may cause a child to exhibit symptoms that look like seizures or fainting spells. I find the relationship between neuro and psych–or, more broadly, the mind and the body–to be absolutely fascinating.

I saw one patient in the adult epilepsy clinic, as part of a direct observation session in which I took a history and performed the physical exam while the attending watched me and interjected where necessary (read: lots of times). The patient we saw not only had trouble recalling old memories, but also seemed to have trouble forming new ones! It was quite a feat to piece together the story from this patient and his family.

In the adult neuro clinic, I worked with an attending who was more than willing to teach and converse as he saw patients. He talked with the patients and me about everything from medications for Parkinson’s Disease to acupuncture to movies about ALS. I even watched him administer Botox injections to a woman with severe migraine headaches–before that morning, I never realized that it was used as a treatment.

My afternoon in peds neuroradiology allowed me to become a bit more familiar with CTs, MRIs, and ultrasounds, all of which I have had little experience with interpreting. It also made me wonder how radiologists are able to sit in dark rooms in front of computer screens for so long, because that can’t be easy on the eyes.

I saw electromyography and nerve conduction studies in the neurodiagnostics suite on my last morning of the rotation. Here, needles and electrodes are used in various ways to help the clinician understand whether particular muscles or nerves might be responsible for a patient’s symptoms. Yes, needles and electrodes. Sticks and shocks, if you will. These studies were a bit difficult to watch because they caused the patients a considerable amount of pain. I understand the utility of these studies, but I still wouldn’t wish them on my worst enemy…

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