Tim loves the teaching and academic side of neurology, as well as the challenge of arriving at a diagnosis. Find out how he's getting on with his training
How did you get your job as a neurologist?
In sixth form I lacked medical role models, so it wasn't until after I'd almost completed a PhD in nanoscience at the University of Cambridge that I applied for medicine.
During my four-year graduate medicine course, I quickly decided that the brain was the most interesting organ. Realising early that I wanted to go into neurology meant that I could focus on this area when choosing optional modules.
After medical school, I took an academic route into the foundation programme, so I had a four-month placement where I did some neuroscience research. After foundation, I completed an Academic Clinical Fellowship (ACF) in neurology (an alternative route to standard core medical training), meaning that during my first three years of training I completed six months of research. I became a registrar in neurology in the second year of my ACF.
What is a typical day like in neurology?
I start at 8.30am with a ward round, visiting neurology inpatients and making care plans. Afterwards, I'll share in completing jobs generated from the ward round, typically ordering tests, discussing outcomes of tests or treatment options with senior colleagues, attending multidisciplinary team meetings and talking to patients' relatives.
Often, for an hour in the morning, I'll teach a group of medical students by seeing different neurology patients with them, or I'll be taught myself.
After lunch, I'll see patients in an outpatient clinic who have a chronic condition, like Parkinson's disease or multiple sclerosis, or who might need rare disease diagnosing. Appointments are 20 to 30 minutes and I'll see ten patients, usually finishing about 5.30pm.
I also have on-call duties. I do these busy shifts about one evening a week and one whole weekend every seven. This involves taking telephone calls from different healthcare professionals asking for neurology advice, or seeing patients with urgent problems like stroke sufferers in A&E. We aim to scan and treat stroke patients within 30 minutes, so it's very fast moving.
What do you enjoy most?
I love using a combination of techniques to arrive at a diagnosis, and the challenge of piecing together the puzzle. What patients tell us is still the best clue, but we also learn by examining them and using neurology-specific tests.
The teaching and academic side of neurology also suits my personality.
What are the challenges?
One challenge is that 10% to 20% of our clinical patients have 'functional disorders', where they have genuine physical symptoms that cannot be explained on the basis of a recognised disease and tests are often normal. However, we do have approaches we can use in these cases to make them better.
How has the role developed?
From the beginning of higher specialty training I took on a lot more responsibility in terms of seeing and treating patients. The five years of neurology training provide a broad and in-depth experience so you can diagnose and treat most neurological problems. Some neurologists decide to become sub-specialists towards the end of training and focus on just one type of condition.
What are your tips for someone wanting to get into neurology?
- If you decide at an early stage to become a neurologist, you have opportunities to show commitment to the specialty by getting involved in projects like audits.
- Academic achievement is highly valued, so writing a publication (even if it's just a case report) or winning a prize is helpful.
- It's a hard specialty to learn, so focus on both clinical skills and book learning.