Mirror mirror on the wall who is the smartest neurologist of them all?

doi:10.15406/jnsk.2023.13.00566

Journal of

eISSN: 2373-6410

Neurology & Stroke

Opinion Volume 13 Issue 6

Mirror mirror on the wall who is the smartest neurologist of them all?

Nitin K Sethi MD

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Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States of America

Correspondence: Nitin K Sethi MD, Associate Professor of Neurology, Comprehensive Epilepsy Center, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA

Received: November 20, 2023 | Published: December 1, 2023

Citation: Sethi NK. Mirror mirror on the wall who is the smartest neurologist of them all? J Neurol Stroke. 2023;13(6):166. DOI: 10.15406/jnsk.2023.13.00566

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Keywords

neurology, teaching, education

Opinion

As a resident physician in training, I quickly came to the realization that some of my attending neurologists were smarter than others. No matter how vexing the clinical problem these were the few who always knew the answers. I would present the history, examination findings, pertinent labs and voila these master clinicians would magically be able to put the pieces of the puzzle together. If they did not know the answer right away, they always knew where and how to look for it. What labs to focus on and what additional tests to order. They stood out in stark contrast to other attendings, all ‘good’ neurologists but who I found fishing for answers by ordering random at times irrational tests as they struggled to find what plagued the patient in front of them. Eccentric with bedside manners that at times bordered on the theatrical, these master clinicians on the other hand made neurology fun and easy. It was as if they could walk into a patient’s room and smell the disease.

I frequently wondered what set these doctors apart from others. It could not be the medical school or the residency program they had graduated from for very few were from Ivy League schools. Many were unknown outside the corridors of the institution they served in as against some of the ‘good’ attendings who made it to the “Best Doctors” list. Was it then their depth of knowledge? Many of my ‘good’ attendings could quote relevant articles and studies with ease but still came up short at the patient’s bedside. I decided it had to be Factor E (excellence factor) coded by the M (master) gene on chromosome N (neurology). Only chosen few had it.

Now I am on the other side of the fence teaching residents and fellows in training, I still wonder whether master clinicians are born anew with copious amounts of Factor E or whether a chosen few physicians become master physicians and the rest of us remain good. A lot has been written about improving neurology residency training. The goal is to pass out competent neurologists at the end of residency training, but can good residents be trained to become master clinicians? Is Factor E teachable and transferable? Does training under the wings of these masters automatically ensure transfer of gene M to the trainee? The field of medicine glitters with examples of master clinicians who taught, mentored, inspiring residents and fellows to become master clinicians themselves.¹

A closer look at these teacher-resident trainee relationships is worthy of our attention. The patient’s bedside is your laboratory is the central tenant that master clinicians teach their students encouraging them to spend time at the patient’s bedside hearing their stories with rapt attention for a small detail in the history may well be the key which unlocks the whole puzzle.¹ Sherlock Holmes the master sleuth once told his prodigy Dr. Watson “you see but you do not observe”. Blessed with astute powers of observation and an analytical mind, master clinicians teach their students that our eyes do not see what the mind does not know. James Parkinson, a master clinician in his own right, in his monograph titled “The Shaking Palsy” described 6 patients in total, three of whom he simply observed walking on the city streets. Much of the description of the longitudinal course of the illness we now know as Parkinson’s disease was derived from his observations of a single case only. Master clinicians report just not their successes but also their failures. Remembering and learning from their failures constantly striving to become better they inspire trainees to follow in their footsteps. Knowing all too well that medicine never was nor shall ever be an exact science, they encourage their trainees not to hesitate to think out of the box when confronted with a vexing case. “When you have eliminated the impossible, whatever remains, however improbable, must be the truth” another quote attributed to Sherlock Holmes is well worth remembering. Last but not the least these shinning stars of neurology teach trainees the importance of treating patients with respect and dignity reminding them ever so gently that our patients remain our best teachers.

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”(William Osler-Canadian physician 1849-1919).