What Is Neurophobia?

Drs. Ashley Paul and Michael Kentris discuss what is "neurophobia" and what we can do to help educate people about neurology to reduce its prevalence.

Transcript:

Dr. Michael Kentris [00:00:00]:

Welcome to the neurotransmitters,

Dr. Ashley Paul [00:00:02]:

a podcast about everything neurology. From challenging clinical cases to practical clinical pearls, with the goal of reducing your neurophobia. We are your hosts, Dr. Ashley Paul, and Dr. Michael Kentris.

Dr. Michael Kentris [00:00:15]:

Hi, Ashley. So after long discussions, we're finally recording. And one of the things we we both have a passion for, I think, is neurology education. So in our intro, and I like that you suggested this, was the inclusion of of neurophobia. And if you will indulge me, I I did bring up a definition from the 1994 JAMA Neurology paper by Dr.  Ralph Józefowicz, which I think sums up a lot of the neurology training that we see out in the wild. Neurophobia can be defined as a fear of the neurosciences in clinical neurology that is due to the student's inability to apply their knowledge of basic sciences clinical situations. What do you make of that diagnosis? That was back in 1994. Do you think that it still holds as true today almost 30 years later.

Dr. Ashley Paul [00:01:12]:

Well, I think we would have to update that to include more than students.

Dr. Michael Kentris [00:01:18]:

So, you know, it does in that article actually reference general practitioners as well. So I do think that there was that concern. So it was still a prevalent problem back then, and, anecdotally, it does seem to be a recurrent concerned when we're dealing with learners from other fields, whether that's internal medicine, psychiatry, emergency, family medicine. And, obviously, you know, we're we're biased, this is our specialty, but it's a specialty that touches on facets of every other specialty. and it's something that unfortunately a lot of people don't necessarily feel that they are naturally inclined towards or have this aversion to our words.

Dr. Ashley Paul [00:02:00]:

Yeah. Why is there an aversion to neurology? I remember when I was graduating medical school, I was one out of three people. going into neuro. And I had friends ask me why am I doing this, like questioning my decisions.

Dr. Michael Kentris [00:02:16]:

Right. Right. There there's this stereotype, you know, that oh, neurology is complicated, that it's esoteric, that you can't make a difference in patients' lives, all that kind of stuff, which are somewhat archaic I would argue at this point in time, which the all the advances that are being made in the field. And there there is that necessary evil. The the knowledge of neuroanatomy is is a prerequisite for the good practice of clinical neurology.

Dr. Ashley Paul [00:02:47]:

This is true. I do remember that being painful as a second year medical student, but I think once you see the clinical application, it just all sort of, like, clicks into place.

Dr. Michael Kentris [00:02:58]:

Yeah. And I I do you know, there's a lot of good books out there that hammer on on some of those points. But one of our, like we said in the intro, our goals are kind of to to address those concerns to reduce your neurophobia. And I think there's a a variety of ways we we wanna go about doing that, you know, on a regular basis. So what are the some some of the things that we're going to look into, Ashley, in terms of broadening people's neurologic horizons?

Dr. Ashley Paul [00:03:31]:

Well, we can go through cases that we've experienced. Some of them could be clinical conundrum. Some of them could be more straightforward, but things you don't want to miss. reviewing journal articles so that people know what's the latest data out there. Because like you said, neurology is evolving, and there are so many more treatment modalities now than there was in the past. And I think we need to undo the stigma that neurology has all these diseases that cannot be treated.

Dr. Michael Kentris [00:04:06]:

Yeah. I agree a 100%. And I think that's great. You know, It's good to vary the the way that we try and further neurology education. and I think all those are great ways of going about it. So I thought for for this first episode, it might be useful perhaps for people in the medical student or even the premedical stage, How did you end up coming to the field of neurology?

Dr. Ashley Paul [00:04:38]:

So that's always a loaded question, but You know, I wasn't going to apply for neurology at all. When I was a 4th year medical student, I had already submitted my ERAS application for med peds. Mhmm. And During the month where my ERAS was submitted, I was on my neurology rotation. So I think this is also part of the problem actually that neurology, even though it's a core curriculum, it's not in the same years across institutions. Right? So some institutions -- Right. Right. required in the 3rd year, which then you get that exposure, and then you may consider it going into the field. Whereas some institutions it's in the 4th year, which was my case. But luckily, I took it early enough. And I just remember every day being so fascinated And I think what really fascinated me was that a lot of these diseases can alter a person's sense of self. And -- Right. Right. You know, it made me really think about the brain and how that relates to self identity and memories. And I guess I was also attracted to neurology because these diseases it can be just so so startling in their presentations. And that was just interesting to see. Like, one of the first cases I saw was a woman with anti NMDA receptor encephalitis.

Dr. Michael Kentris [00:06:14]:

No. That's a doozy.

Dr. Ashley Paul [00:06:16]:

Right. And her family described her as someone who could manage a car dealership and, you know, had no issues at baseline. And then during her 3rd trimester of pregnancy started having seizures, but didn't meet criteria for eclampsia. And after she delivered, her cognitive state was no better. So I I just recall interacting with her and asking her basic questions like how many quarters are in a dollar, and she would just sort of repeat it back to me what this sort of dazed look. And it just it was just so fascinating how, like, this these diseases just transform people. and how we can serve as a bridge to help them get back to some semblance of normalcy, whatever that normalcy might be, right, for certain diseases. You might have to establish a new normalcy if there's it's chronic and progressive. Very true. But some of these other diseases, like anti NMDA receptor encephalitis, we've had patients that made a complete recovery.

Dr. Michael Kentris [00:07:22]:

Yeah. There's there's a lot more options, and the The outcomes can be much better than they were even just a decade ago.

Dr. Ashley Paul [00:07:30]:

Yeah. Exactly. I mean, I could think of so many examples like that even in the world of movement disorders, which -- Mhmm. -- I was just talking to my medical student today about this. So he said that when he before doing this rotation with us, he felt like that same thing that many people feel, which is why do neurology? There are just a bunch of incurable diseases or chronic diseases. you there's nothing you can really do. You just make the diagnosis, and that's it. And his experience rotating with us in our clinics showed that there's that he can do for all these patients and that we don't just, you know, throw cinimed at patients with Parkinson's disease, but, you know, we address a lot of it. Well, we do give them the gold standard medication. Yes. But but we also, you know, address their cognitive issues or They're I mean, I even prescribed medications for urinary incontinence 

Dr. Michael Kentris [00:08:34]:

Right. Now that's a a good point. Now you're doing a fellowship right now. Correct?

Dr. Ashley Paul [00:08:40]:

Yes. So I'm doing my fellowship in movement disorders at Johns Hopkins.

Dr. Michael Kentris [00:08:46]:

And you're in your 2nd year of fellowship there.

Dr. Ashley Paul [00:08:50]:

Yes.

Dr. Michael Kentris [00:08:51]:

And you know, what what was it that drew you? You know, like you said, just now, right, neurology is such a vast field. What led you towards movement disorders as specialty, and what what is kind of encapsulated in that specialty?

Dr. Ashley Paul [00:09:06]:

So I think I was drawn to movement disorders actually since medical school too. I had a chance to spend time with the movement disorder clinic at my med school. And I appreciated that these patients are chronically ill. And so you have the opportunity to develop longitudinal relationships which I really liked. There were so many advancements already coming out in the field. You know? Like, deep brain stimulators for Parkinson's disease or for essential tremor. And it's so transformative. It's like magic.

Dr. Michael Kentris [00:09:42]:

Yeah. Some of those videos online are pretty amazing.

Dr. Ashley Paul [00:09:45]:

Yeah. Imagine seeing that in person. You're the one who makes it happen.

Dr. Michael Kentris [00:09:50]:

Just the push of a button. Right? Yeah. It's very satisfied. I can only imagine.

Dr. Ashley Paul [00:09:56]:

So Getting back to the point, there is a lot we can do in neurology for patients.

Dr. Michael Kentris [00:10:02]:

Your passion for Parkinson's and Movement disorders is certainly coming through.

Dr. Ashley Paul [00:10:09]:

Yes. I do love it, and I love the patient population I see. I think I I just really love old people also. Not that I don't like my young patients, but they're just, like, the sweetest people.

Dr. Michael Kentris [00:10:23]:

Yes. Yes. There are certainly. And like you said, that longitudinal relationship, many neurologists become kind of like the primary point of medical care for a lot of these patients, you know, with Parkinson's disease, other chronic neurologic issues. just because it is something that perhaps their usual primary care doctor isn't as comfortable or knowledgeable about. So they they do rely on their neurologists to a large extent. And, you know, as as we know, right, there is a now more shortage of neurologists. So again, kinda coming back to our whole purpose is to increased knowledge to help the population at large in terms of caring for these patients.

Dr. Ashley Paul [00:11:10]:

Yes. Exactly. And hopefully, in parts medical students listening to this to consider neurology because it is such an amazing and rewarding field. You will never be bored. I also would make the argument that, you know, a lot of people look at these, again, chronic diseases as incurable and progressive and I mean, diabetes is also a chronic disease that most people don't, you know, reverse just through diet and exercise alone. So I think every field has its chronic patients that they have to follow and treat.

Dr. Michael Kentris [00:11:43]:

That is true. Yes. You know, you can't otherwise, if it weren't work, they wouldn't call it work. So it's always good to find some spark of joy in your day to day activities, but but there will be those challenging moments.

Dr. Ashley Paul [00:12:01]:

Yes. Definitely. Yeah. But even after those challenging moments even in through those challenging moments, sometimes you find a rewarding experience too. like, when I had that patient in residency with crypto meningitis. Yes. Yes. And I had to sit down with a family of, like, twenty people. Oh my. It was just me and the family and the nurse, and she thankfully also called in the chaplain event. Yeah. You know, I learned to tell them bad news. But it was nice to be able to connect with them, you know, on a emotional level and I don't know. It's it was very sad, but it was also in some ways. I don't know if I would call it rewarding because it was Not oh, it's an unhappy ending, but --

Dr. Michael Kentris [00:12:58]:

Right. Knowledge that you did did the best you could and you know, provided closure for the family.  Exactly. -- answering, making sure there's no lingering questions.  And that is a way in which neurology intersects with another field, palliative care where we, unfortunately, frequently do do have some overlap with that field in terms of end of life discussions and, planning for end of life care, and, some of these diagnoses, we see that coming down the road sooner than others. Having a frank and open conversation is an important part of that I know when I was a a fellow. I spent some time in the ALS clinic, and, obviously, that is very much present, you know, we know this person has ALS, and we know that they likely have so many years left based on their progression and so on and so forth. And, yeah, Having those conversations sooner rather than later so that both the patients as well as their loved ones are able to make appropriate plans is is a very important part of neurology. So even though we don't, quote, unquote, treat it, Treating the patients, not the disease, is is really the goal.

Dr. Ashley Paul [00:14:21]:

Exactly. Meeting them, meeting the patient and their family where they're at.

Dr. Michael Kentris [00:14:27]:

Exactly.

Dr. Ashley Paul [00:14:28]:

Yeah. I know. Like, some people's goals are to be able to walk their daughter down the aisle. for her wedding. Right. So, yeah, you know, I it's kinda -- -- about how I can titrate the Sinemet to make that happen.

Dr. Michael Kentris [00:14:45]:

Exactly. Like, you gotta eat this, this, and this. You know? Start to stopwatch. But yeah. You know, and that that is satisfying from a, you know, medical practice perspective, you know, as a physician, providing even that small comfort to people who are dealing with very challenging situations.

Dr. Ashley Paul [00:15:09]:

Yeah. Yeah. And sometimes just being there makes all the difference.

Dr. Michael Kentris [00:15:15]:

Yeah. And it is something that is neglected, unfortunately, more often than not.

Dr. Ashley Paul [00:15:21]:

Well, the other thing I also love about neurology and part of the reason why I went into movement disorders is is how much well, how much your diagnosis is reliant on the exam and the localization.

Dr. Michael Kentris [00:15:35]:

Right. So, yeah, that that is an excellent point to bring up. Right? The the neurologic examination

Speaker C [00:15:44]:

Donching to every medical student. Yes. Right? And to some attendings, I have gone consulted.

Dr. Ashley Paul [00:15:50]:

to do a neuro exam.

Dr. Michael Kentris [00:15:52]:

Going forward, again, we'll be looking into different case presentations, kinda do a walk through of how we would approach a patient, things that would go on the differential, potential treatments that we see in our clinical practice, and then we'll hopefully have some colleagues on intermittently to go through kinda have roundtable discussions on journal articles, newly developing findings, and treatments in the field of neurology and medicine at large potentially, and hopefully have some stimulating discussions that will continue to both be interesting to the new learner in the neurology field as well as those who have been practicing neurology.

Dr. Ashley Paul [00:16:44]:

because we all have something new to learn.

Dr. Michael Kentris [00:16:47]:

Absolutely. Too much. Too much to learn. 

Dr. Ashley Paul [00:16:54]:

But that's why we're here.

Dr. Michael Kentris [00:16:56]:

Yes. Right? So going forward, and we would also love to have any listener questions or suggestions for future topics, emails to the neurotransmitterspodcast@gmail.com