Neuro Docs, the Difficulty in Keeping them Straight

I once started a lecture with this joke: the most important thing to being a brain injury lawyer, is learning how to type neuro.

It sometimes feels to me, and I am sure as often to the readers of my various web pages, that there are just too many specialities with the word neuro in them. I sometimes have a hard time sorting out the neuro this’s from the neuro thats. Sometimes the specialities can’t even agree on how to spell their speciality. Take for example, the neurootologists, who are specialists in the vestibular system. The same peer reviewed literature will spell the word: neuro-otologist, neurootologist (my preferred spelling) and neurotologists.

Any way, here is my “frontal lobe test” for myself: Name all of the neuro docs I can type in 30 seconds:

neurologist
neuropsychologist
neurootologist
neuroradiologist

If you gave me extra time, I would add… neurosurgeon, neuropsychiatrist, neurobehavioral scientist, and neurolawyer. But I am not sure that the last two are in the actual book (if there were one.)

Neurologist. Most people understand what a neurologist is – a medical doctor who specializes in the neurological system. Most people interested in brain injury don’t understand that the study of neurology is so broad that brain injury only makes up about 1% of what these doctors do. To improve your odds, try to find a “behavioral neurologist.”

Neuropsychologists – these are not medical doctors, but psychologists, who at their best are neurobehaviorists, and at their worst, are test administers, who will take the concept of lieing with statistics to obscene proportions. Neuropsychology is fundamentally based upon the theory that brain pathologies, even though they cannot be directly seen in live subjects, leave behind patterns of behavior that can pinpoint where the pathology is. In its most basic form, it is based on written tests, which will show a pattern of results, where the areas of the brain affected by the pathology, will cause the test subject to do abnormally worse on the test. But any neuropsychologist worth your time, will clearly realize that the role of neuropsychology is not to administer and interpret tests, but to do a full “neuropsychological assessement” that is not a statistical process, but an analysis of all of the “footprints of pathology”, that the written test patterns, are only a small proportion of. In the coming days, I will devote an entire blog (or perhaps series of blogs) to neuropsychology, the hope of my youth as a plaintiff’s lawyer, and the bain of my maturity as one. For more on my theory of the “footprints of pathology”, click here.

Neurootologists are doctors who specialize in the vestibular system, the remarkable and complex way in which your inner ear provides the body with a gyroscope. For more on the vestibular system, click here. Some of the best neurootologists are the ones that started as neurologists, and became more specialized in the disorders of balance and vertigo, but EMT doctors who did a fellowship in the vestibular system qualify as neurootologists as well.

Neuroradiologists are radiologists who specialize in the brain and spine. Radiologists are doctors who specialize in reading diagnostic tests such as XRay, CT scans and MRI. Most of the work of the modern neuroradiologist is in CT and especially high field strength MRI. For more on neuroradiology, click here.

Neurosurgeons are surgeons who do brain and spinal surgery.

Neuropsychiatrists are psychiatrists who cross over into the field of neurology and neurobehavior, where there is an interplay between emotional/psychiatric disease and organic processes within the brain. The irony of course in that definition is that it should apply to all brain specialties, as it is “all in the head”. Again, a topic for a blog of its own, more properly a book of its own.

Neurobehavioral scientist is somewhat my own term. I think it is the role that neuropsychologists should play, on an increasing level. The most important “footprint of pathology” is the change in a person’s behavior, and particularly that change in behavior in the real world. The problem with neurobehavioral science, is that it doesn’t reduce itself to statistical analysis, doesn’t make for definitive research studies and requires subjective analysis. Well, the reason these doctors went to school for all these years, is that they could use subjective judgment to make complicated diagnosis. The human mind is far too complex to diagnose the interplay between organic pathology and emotions, without subjective judgments of trained and experienced professionals. If you doctor is not a neurobehavioral scientist, you have the wrong doctor.

Neurolawyer? There is no such specialization, at least not a recognized one. I consider myself to be a neurobehavioral expert, but not a medical expert, nor a psychological one. I work almost exclusively in the field of brain damage, and have learned from and challenged the best medical/psychological minds in the country with my inquiries, questions and depositions. But most of what I have learned has been from you – the survivors of brain injury and the family members of those survivors. I keep learning, I keep writing, I keep asking the tough questions, the questions that because I cannot be pigeon holed into any of the above specialities, often are questions that require thought, and hopefully research to answer.