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Straight to the head

Neurologists have to meticulously trace the medical history of the patient and minutely study the symptoms to arrive at a precise diagnosis. Read on to know more.

education Updated: Sep 22, 2011 11:59 IST
Ayesha Banerjee

I When they brought her to Dr J D Mukherji, head, neurology, Max Super Speciality Hospital, at Saket, this beautiful 22-year-old-woman from overseas and newly married, was almost dead.

The victim of a near-fatal accident, she was bedridden, curled up like a foetus, barely able to breathe without assistance. A caretaker had to be with her constantly to help her do even the smallest of tasks. She had been taken to a premier hospital where the doctors had simply given up on her…

“When I was entrusted with the challenge I was not sure of the results, but God was with me and after three sessions of Botulinum toxin and hard work done by the rehabilitation team, she stood up, walked… Today, she is a proud mother,” says Mukherji.

The fact that miracles are a part of a doctor’s life was what compelled Dr Manjari Tripathi, associate professor, NIH Fellow (UCLA), Department of Neurology, AIIMS to opt for medical science. She decided to specialise in neurology soon after finishing her basic medical degree, “because the challenges that the subject of neurology pose for the doctor and the patient are fascinating and enticing”. Tripathi feels quite like Sherlock Holmes as her work involves developing deduction skills and learning since “neurology is the most logical sciences of medicine. It also has the maximum scope of research and discovery as scientists are still unravelling the mysteries of the brain,” she says.

Neurology is different from neurosurgery in as it deals with managing patients who have disorders of the brain, nerves and muscles, which do not require surgery for treatment. Neurologists have to meticulously trace the medical history of the patient and minutely study the symptoms to arrive at a precise diagnosis. They treat cases of epilepsy, headaches, cerebrovascular accidents like ischemic and haemmorhagic and venous strokes, neuroinfections, neuropathies, movement disorders like Parkinson’s disease, sleep disorders, dementias, systemic disorders which effect the nervous system; muscle disorders, disorders of neuromuscular junction like mysthenia gravis etc.

Studying neurology involves need for being prepared for two types of lifestyles, says Tripathi. “Acute neurological emergencies are aplenty in our country, most of them preventable and many of them lifestyle-associated.” Be prepared for boot camp training, “but that is what makes you shine”, she adds.

The discipline can also only be reinforced by good teachers.

Tripathi also has to deal with emergencies because cases of brain stroke brought to her require immediate intervention. She is often rushed off her feet organising emergency care for cases of epilepsy, tuberculosis in the brain, encephalitis due to viruses, and respiratory paralysis due to neurological causes etc. “I am on my toes rushing the patient for imaging of the brain so as to not miss the time window of treatment in ischemic stroke, which is within three hours of the event, to start the doses of medication at the right time,” she adds.

What should the mindset of young people (say senior school students) who want to enter this profession be like?
“It’s an excellent career, very challenging requiring utmost dedication. One should be ready for long and intense hard work,” advises Dr Mukherji.
About growth prospects, he adds, “Neurology as a science has recently shown newer therapeutic modalities which throw up new challenges. One has to constantly update his/her knowledge.”

What's it about?
A neurologist treats cases of epilepsy, headaches, cerebro-vascular accidents like ischemic and haemmorhagic and venous strokes, neuro infections, neuropathies, movement disorders like Parkinson’s disease, sleep disorders, dementias, systemic disorders which effect the nervous system, muscle disorders, disorders of neuromuscular junction like mysthenia gravis etc

Clock Work
This is what Dr J D Mukherji’s daily schedule is like
8.30 am: Start work, attend teaching sessions, take a round of the ICU and interact with patients’ relatives
10 am: Start OPD and attend emergencies and between patients check references from other departments
3 pm: Have a quick bite, unwind a little and then oversee the electrophysiology work, read up on Botulinum Toxin and other treatments
6.30 pm: I wind up the rest of the OPD and start the evening round which usually ends after 8.30 pm on a good day. If there are emergencies, then one doesn’t
know when the day will end

The Payoff
A neurologist in the government sector would start at around Rs80,000 to Rs90000 per month (Post Sixth Pay Commission) and in the private sector, after a few years experience, would be earning anything from Rs1.5 lakh to Rs5 lakh per month

Skills
. Should be able to diagnose ailments and prescribe a quick cure
. Also have the ability to go beyond the call of duty and ensure a patient’s comfort and survival
. Endless patience to listen to and empathise with a patient
. Excellent communicative and research skills

How do i get there?
.
Focus on science subjects at in senior school, especially biology. Concentrate on botany and zoology at the plus-two level. You have to then give the entrance
exam for a medical college. After your basic MBBS, you have to do your MD medicine/paediatrics for three years and then another three years for your
DM/DNB neurology. After that, most would like to do an additional fellowship. Seats at DM level are very limited – just 62 seats across the country

Institutes & urls
. PGIMER, Chandigarh
www.pgimer.nic.in
. AIIMS New Delhi,
www.aiims.edu
. National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore
www.nimhans.kar.nic.in
. Sanjay Gandhi Postgraduate Institute of Medical Sciences, (SGPGI) Lucknow
www.sgpgi.ac.in
. GB Pant Delhi
www.health.delhigovt.nic.in/Hospitals/GBP/default.html

Pros & Cons


.

It’s immensely satisfying to save lives and to cure people of their suffering


.

It’s a much respected profession and doctors have a good status in society


.

The money is good, and if you set up a private practice you can earn unlimited amounts of money


.

Neurology case evaluation requires a lot of time,patience and correlation with radiology/lab services


.

Very stressful as you have to spend long hours at work

Access to neurologists abysmally poor

A practitioner talks about the need to have more players in the field

Do a lot of sweat, toil and tears go into the making of a neurologist?
Yes, after your basic MBBS you have to do your MD medicine/paediatrics for a period of three years and then pursue DM/DNB neurology for another three years for your. After that most would like to do an additional fellowship. Seats at DM level are very limited – just 62 seats across the country.

Why neurology? When did you take the decision to specialise in this field?
Neurology was my passion even at the MBBS level when I was very impressed by my medicine professor, Dr PC Sathpathy, who diagnosed cases with mathematical precision. During my MD medicine at Bangalore I was attached for neurology training at NIMHANS, which rekindled this passion. The huge workload, fascination for teaching and upcoming treatment modalities were prime motivational factors which led to my studying neurology. I was already serving in the Army Medical Corps (AMC) when I was picked up at a very early stage by the Army and granted study leave for doing neurology. I got selected at PGIMER, Chandigarh, in the first attempt and after clearing my DM in the first attempt. I am a graduate from the VSS Medical College, Sambalpur, in Orissa. I have worked in the command hospitals of Bangalore, Lucknow, and Kolkata. Before taking premature retirement from the Army, I was in the Faculty at Army Hospital (R&R) which is under Delhi University and is the Apex Armed Forces Hospital.

Is treatment expensive and how can it be made accessible to the general population?
Mostly no, but some drugs like interferon and Botulinum toxin are very expensive. We need to train more neurologists and impart additional training to our young physicians

Do we have the facilities or the required number of doctors?
Access to neurologists in our country is abysmally poor and that too limited to the metropolitan cities. In the US there are more than 10,000 neurologists, but in India there are hardly 1000 fully qualified functional neurologists.

Is it a stressful job?
Very, Neurology case evaluation requires immense time, patience and correlation with radiology/lab services. My colleagues and I spend approximately 72 to 80 hours a week in the hospital

Dr J D Mukherji Interviewed by Ayesha Banerjee