"Just so I understand, you're consulting me because the patient has a brain and you don't understand it?" Dr. Glaucomflecken nails it with his hilariously accurate neurology character. Neurology tends to make doctors uncomfortable, to say the least.
The term "neurophobia" was first coined in a 1994 JAMA article to describe the pervasive fear of clinical neurology among medical students. Of course, now we know that the problem extends to physicians in all stages of their careers and all over the world. The downstream consequences of neurology's poor public perception may compromise patient care, both because neurophobia discourages trainees from choosing to pursue neurology and because neurophobia discourages physicians in other specialties from getting comfortable with neurologic diseases.
Understanding the roots of neurophobia is essential so that we can identify opportunities for intervention that will allow for promotion of a more "neuro-positive" culture.
A systematic review of studies that examined the key factors behind neurophobia identified difficulty in learning neurology relative to other specialties and lack of confidence concerning neurology as the most relevant factors. After students get off on the wrong foot with neurology, a vicious cycle of "neuroavoidance" develops. If medical trainees aren't learning enough neurology, how can we expect them to treat patients with neurologic disease?
The future availability of neurologists may depend on our ability to make the specialty more accessible to students. Moreover, the upcoming projected shortfall of practicing neurologists in the US will almost certainly mean that other providers, such as primary care physicians, will be forced to confront their neurophobia in order to care for their patients.
The solution is crystal clear: We have to revamp neurology's public image. So, where can we start?
It Starts Before Medical Students Hit the Wards
The neurology curriculum in medical school is often thought of as a deluge of basic science material and complex neuroanatomy, with limited application of this at-times tedious material to clinical context. Just like learning in any medical field, it's important to foster a sense of familiarity through ample, repeated exposure to neurologic pathologies. That's the best way to instill confidence in medical trainees.
Neurology educators are in the position to inspire enthusiasm and comfortability for the field if they can find ways to communicate with excitement and to stick to the information that's most practical for trainees to grasp.
Clinical Exposure Should Play to Neurology's Strengths
Other fields can rely on tons of lab results and other test data to make a diagnosis. That's not always the case in neurology. It's one of the specialties that is most reliant on true clinical acumen. Making a neurologic diagnosis requires masterful integration of history, physical exam, and test data. That unique intellectual challenge can be very satisfying and is a real selling point for the field.
But, let's face it — neurologists often hear hoofbeats and can't help but talk about all the zebras in our field. Rare neurologic diseases are as fascinating as they are intimidating to learn about. But the horses in our field are also interesting and, more important, extremely useful learning cases that can showcase the neurodiagnostic processes.
Old Stereotypes Need to Be Challenged
The old "diagnose and adios" trope really doesn't hold up today. Recent years have brought us many dramatic advances in therapeutic and preventive neurology as well as in neurorehabilitation. We should be showing off all these breakthroughs! Practicing neurology in 2022 is less "diagnose and adios" and more "localize and optimize."
As future generations begin medical training, social media will be an increasingly important tool for education. There is already a Twitter movement, #EndNeurophobia, that is setting out to demystify our field. Boiling neurology pearls down to Twitter-sized bites is exactly the kind of thing that neurology education needs. Plus, social media allows us to highlight recent advances and interesting cases for a wide audience.
How do you think neurology's image can be rehabilitated? Comment below!
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Cite this: Leah Croll. Neurology Has a Public Image Problem - Medscape - Mar 02, 2022.