What is a Neurologist?

Simply said, a neurologist is a doctor who takes care of patients with disorders affecting the nervous system. The nervous system is complex and involves all the nerves from your brain to your nerve endings and muscles. Neurologists care for patients with many common conditions like migraine, stroke, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, seizures, and peripheral neuropathy. We also care for patients with rare conditions like myasthenia gravis, ALS, multi-system atrophy, progressive supranuclear palsy, and spinocerebellar ataxia.

Historically neurologists were thought of only as diagnosticians. Other physicians think of us as brainy and in the past would make fun of us saying that we only make diagnoses but do not really “do” anything for patients. It is true that we do like to play detective, and we are often good with our analytical skills. But over the last two decades there has been a huge growth in treatments for neurological conditions, so we have also become good at treating patients, most often with medication. Unfortunately, we do not usually “fix” our patients. Most neurological conditions are managed or treated and not “fixed.” This is often difficult for patients and loved ones and caregivers to understand and accept. Fortunately, we are physicians who like to have long term relationships with our patients as we help them navigate their neurological condition and hopefully help them manage it and improve their quality of life.

We are not neurosurgeons, so we do not perform surgery but we do share patients with neurosurgeons in cases where both surgery and medication are necessary. We are not psychiatrists so we do not take care of primary psychiatric conditions like bipolar disorder and schizophrenia. We share our roots with psychiatry and our board is shared with psychiatry, The American Board of Psychiatry and Neurology. Sigmund Freud was a neurologist first before he developed his theories of psychoanalysis.

Neurologist come in two varieties: those who like to stick needles in people and those who do not. Perhaps because I am a sensitive person, I am in the category of “do not.” Those neurologists who do like to do procedures are the ones who do EMG/NCS (electromyography/nerve conduction studies) and Botox for migraine and dystonia. When one of my patients needs to have a procedure, I refer them to one of my partners. I most enjoy spending time in the office visit talking with the patient, obtaining a history and then performing a neurological exam and analyzing data such as MRI scans and lab results. I like to tell patients, “I am a neurologist; I like data.” Neurologists are usually orderly thinkers and detail oriented.

Neurologists also tend to divide up based on what part of the nervous system is affected. Most of the time neurologists tend to focus either on the central nervous system or the peripheral nervous system. The central nervous system includes the brain and spinal cord. The peripheral nervous system includes the nerve roots, peripheral nerves, and muscles. I tend to see more patients who have central nervous system conditions like migraine, MS, stroke, Alzheimer’s, Parkinson’s and seizures. I did a stroke fellowship after my residency training in neurology. But I love to see patients across the neurological spectrum, so I also see patients with pinched nerves, peripheral neuropathy, myasthenia, and myopathy.

I practice neurology in a group practice with several other general neurologists. Even though I have sub-specialty training in stroke, I love the variety of general neurology practice. Some neurologists practice only in their sub-specialty. For example, some neurologists only see patients with MS at an MS Clinic or ALS at an ALS Clinic.