why study neurology?

Nick Medford nick at hermit0.demon.co.uk
Sat Jan 12 23:22:23 EST 2002

In article <3c3fc27c.50041730 at news.freeserve.net>, James Teo
<james at teoth.fsnet.co.uk> writes
>I initially thought that neurologists would be able to be delve into
>cognitive issues of neuroscience which I find interesting, but on
>seeing the specialty, I have come to realise a lot of neurology work
>is bread-butter stuff and more about muscles, nerves and neurons
>rather than thought processes.

This is very true, in the UK at least. The primary areas of research are
movement disorders and demyelinating disease. Stroke has been
somewhat neglected considering its prevalence (and
morbidity/mortality) but that has changed in the last few years. 

Neurocognitive conditions are not a primary area of interest for most
British neurologists, although there are of course exceptions e.g. the
dementia research group at the Institute of Neurology, or the work done
by Hodges and colleagues in Cambridge.

> Interesting nonetheless but not the
>actual initial interest. OTOH the other specialty which can lay claim
>to cognition is psychiatry

Indeed. And this was one of my main reasons for switching specialities-
I felt the really interesting questions were to be found there. 

> and I find it awash with a different
>culture of thinking which I am not used to.

Well, psychiatry is actually a very broad discipline- you don't have to
be, say,  an unreconstructed Freudian, in fact very few people are

However I would say that the kind of reductionist/determinist certainties
that have been aired in this thread so far are worse than useless when it
comes to trying to understand what makes people tick and how one might
help them.

> I think the most
>interesting area would be the gray area in the centre

music to my ears!

> where neurology
>and psychiatry meet,

i.e. neuropsychiatry or cognitive neurology (behavioral neurology in the
US), depending which side of the fence you're on.

> and it will be interesting to see which specialty
>will muster the courage to stake claim to that territory. 

I think it will have to be a combination of both. Certainly that is the state
of play at present.

>Between the two, I probably will end up on the side of neurology for
>more mundane reasons (neurology is much less culture-sensitive when
>practicing internationally, neurology more likely to bring home the

This last is probably true! (contrary to what someone posted earlier). I
have yet to meet a consultant neurologist who doesn't have a substantial
private practice.

One other point to consider is on-call rotas etc.: traditionally psychiatry
is less demanding in terms of on-call duties, although obviously it varies
depending on where you work. But I went from  1 in 4/1in 5 type rota in
neuro to a 1in 12 in psych.  Big change in quality of life I assure you. For
the first few years after qualifying I didn't mind working very long hours
but this changes over time, particularly once you have family ties etc.

>etc). Also, I feel that effective treatments that I can give
>patients (cognitive disorders or not) are more realistically available
>in my lifetime for neurology than in psychiatry. 

This statement surprises me though- treatments in psychiatry are far from
ideal but at least one can usually do *something*, which is often not the
case in neurology, at the present time anyway. This difference was
another thing I found refreshing when I switched.
>And at heart, I am
>more comfortable approaching things biologically rather than
>psychologically, although that does not mean I would totally discard
>one for the other. Not to forget that the most common diseases of the
>nervous system (strokes, Alzheimer's) have a distinct cognitive
>However, I do think that the subspecialty of neuropsychology might
>take off 

Neuropsychology is a branch of psychology, not medicine. Sorry if that
seems like nit-picking, but it's a very well established field in its own
right and its practitioners would probably be surprised to read that "it
might take off". The doyenne of UK neuropsychology is Prof. Elizabeth
Warrington, who has been pushing the field forward for some 40 years

>on its own (cognitologists or something like that) in the
>next 1-2 decades if progress in neuroscience keeps going, and attract
>people from neurology and psychiatry (rather like how the A&E
>specialty was born and now attracts both surgeons and medics).

It is my hope that this will happen, but there will need to be some
flexibility on the part of the Royal Colleges. Currently neuropsychiatry is
not  a recognised subspecialty and the only way to practise it is to train
in psychiatry (prior experience in general medicine and neurology is
obviously an asset) and try to get jobs that have the right "flavour" as one
moves up the ladder. There are very few places that have bona fide
neuropsych departments. 

Similarly, if coming at it from the neurology angle, one needs to train
within general neurology and try to get the appropriate placements and
hook up with an interested research supervisor.

I believe the situation is very different in the US where there are
dedicated training schemes in both neuropsych and behavioural

>Basic background, so that you know how much salt to take with my above
>views: Final year medical student, 
>trained at Oxford and Royal Free.

Well good luck for finals, I presume they're coming up in summer. I
trained at Charing Cross. I worked at the Free some years ago, excellent
neuro dept. there (nice part of town too... ). 
>Picked up neuroscience and psychology interest in Oxford, and popular
>science reader of cognitive science rather than any real scientist. Do
>have inclinations to PhD or DPhil though, and avidly eyeing the ION in

You and many others by the looks of things! I work at the IOP

Anyway I see that no-one has taken up any of the gauntlets in my
previous post, so I await replies with interest. 
Nick Medford

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