The Daily Schedule Of A Neurologist

A neurologist is a medical specialist who deals with the diagnosis and management of illnesses and issues that affect the central (brain, brain stem and spinal cord) and peripheral nervous system (nerves extending into the upper and lower limbs) of the body. 

Neurologists will manage conditions such as strokes, epilepsy, sleeping disorders, rehabilitation of brain injuries, multiple sclerosis and movement disorders such as Parkinson's disease.

Training

A doctor wanting to specialise in neurology will spend around 13 years training to become a neurologist. After obtaining the undergraduate medical degree, which takes 5-6 years to complete, a newly qualified doctor then has to complete another 1-2 years in their internship training. Thereafter, they will apply for a post in internal medicine and if they are successful they will be entered into this residency programme which takes 4 years to complete.

The newly qualified specialist physician then wanting to specialise further in neurology, will have to be accepted to complete a postgraduate college degree in neurology that will take another 2-3 years to complete.

Sub-specialties in neurology are available for specialist neurologists who want to train further in a particular field. These fellowship programmes are available for the following:

• Headaches
• Epilepsy
• Multiple sclerosis
• Vascular neurology (stroke)
• Child neurology
• Neuropsychiatry
• Neurocritical care
• Clinical neurophysiology 
• Neurodevelopmental disabilities
• Brain injury medicine
• Neurorehabilitation
• Neuromuscular medicine
• Neuroimaging
• Hospice and palliative medicine
• Pain medicine
• Behavioural neurology
• Interventional neurology
• Sleep medicine

The Clinical Tasks of a Neurologist

A neurologist will consult with patients that have been referred to them by other healthcare professionals such as primary healthcare nurses, general practitioner and even other specialists.

The neurologist will start by taking a comprehensive history from the patient including a family history of any neurological issues, a history of any chronic conditions that can affect the neurological system such as hypertension and diabetes and whether they are using any acute or chronic medication.

The neurologist will then move on to examining the patient and this consists of looking at aspects such as the mental health status of the patient, the cranial nerves, motor strength, sensation, reflexes, coordination and gait. The history taking and examination will help the neurologist in drafting a differential diagnosis of what the problem may be that's affecting the patient.

READ Deep-Brain Stimulation Offers Flip Of A Switch Solution For Neurological Illnesses

The specialist will want to perform further investigations to help them narrow down this differential diagnosis list and ultimately determine the patient's diagnosis. Tests and investigations that are used include the following:

• Blood tests - routine bloodwork is done to rule out signs of infection.
• Lumbar puncture test - where fluid form the spinal canal (cerebrospinal fluid - CSF) is collected to determine if there are any infective markers or microorganisms present. This is done to rule out illnesses such as meningitis.
• CT scans of the brain - done to rule out strokes and any other issues that can affect the brain.
• MRI scan of the brain.
• Ultrasound of the blood vessels of the neck.
• EEG (electroencephalogram) - done to diagnose epilepsy.
• EMG (electromyograph) - done to help exclude conditions such as muscular dystrophy and polymyositis.
• NCSs (nerve conduction studies) - done to rule out nerve related complaints such as that caused by carpal tunnel syndrome (CTS).

The Daily Schedule Of A Neurologist 

A neurologist will consult with their hospital patients 1-2 times a day, when needed, and they will continue with the management of the patient until they are ready to be discharged. These specialists will also have patients in the intensive care units (ICUs) that have to be seen at least daily. In the case of patients who have suffered brain trauma or those who need further rehabilitation, such as stroke patients, will be transferred to rehabilitation hospitals to receive further management.

Neurologists have their practices based in the hospital they work at as this allows them to quickly get to admitted patients and those in the casualty department, if there's a medical emergency. 

Neurologists have to provide on call services after hours and on weekends for the hospital they work at. They may need to be on call 3-4 times a week depending on how many neurologists are working at that particular hospital. These specialists will receive calls from nursing staff regarding patient care, and from other healthcare professional looking for an opinion or wanting to refer patients to them.

Emergency neurological cases include persistent convulsions due to conditions that affect the brain such as a severe infection, acute strokes, severe headaches that don't resolve even with treatment and convulsions affecting a single-limb, as this can point to issues such as an intra-cranial tumour. 

Monday

This is usually an administrative day where tasks such as meeting with relevant stakeholders and medical reps are confirmed for the week, paperwork is done and the call list is confirmed.

The neurologist will then start consulting with patients once all the administrative issues have been dealt with. Patients will be managed either conservatively, with a prescription and referral to other healthcare workers such as physiotherapists, occupational therapists, etc., sent for further investigations as out-patients or admitted to the hospital for further tests and management.

Tuesday

Neurologists consult with patients with many different neurological disorders and conditions. Therefore, they may decide to break up the week by seeing specific patients on different days. A Tuesday, therefore, can consist of consulting patients who are referred as epileptic, newly diagnosed epileptic or epileptic patients that are seen as part of their follow up. 

Attention deficit with/without hyperactivity disorder (ADD/ADHD) patients may also be seen on this day.

Wednesday

On this day the neurologist may decide to hold a stroke clinic. They will then see newly diagnosed stroke patients who have recently been discharged from the acute or rehabilitation hospitals, and long-term stroke patients who follow up for further examinations and prescriptions.

READ Questions To Ask Yourself When Wanting To Study Medicine

Thursday

The neurologist may decide to have a headache clinic on this day where patients with severe headaches such as migraines and cluster headaches are consulted, investigated and managed.

If the neurologist is involved with the academic setup of the medical institution, they will offer training to undergraduate medical students and postgraduate registrars.

Friday

The neurologist will consult with patients in general and then finalise any outstanding administrative issues for the week. The specialist who is on call will then look after their patients and those of their colleagues for the weekend.