President's Column

Read archives from AAN Past President Orly Avitzur, MD, MBA, FAAN, who served from May 2021 to April 2023.

February 2022

For the Love of Neurology

When I started business school in 1997, there were four other physicians in my class. As they speculated about how they would change careers while we learned about new fields such as economics, finance, and management—and eventually, did just that—I could not help but think about how those choices paled compared to neurology. The thought of giving up clinical practice made me sad, and the prospect of a future without our profession unimaginable.

Twenty-five years later, as I write this February column, I am certain that I made the right decision. Although the frustrations that led me to pursue an MBA—the beginning of regulatory changes in health care including the introduction of the resource-based relative value scale (RBRVS) system in 1992, which changed the way Medicare paid for physician services, and the intrusion of insurance mandates that interfered with clinical care decisions—have only increased over the past quarter century, I still love the practice of neurology.

Indeed, it is the love of neurology which binds us all together: specialists and generalists, private practitioners and academicians, researchers and trainees, and other members of the health care team. I think a lot, these days, about commitment to our field as many of you are battling a fifth COVID-19 surge and are understandably bone tired. Some of you have spoken to me about the feeling of futility as unvaccinated patients are filling your hospitals again, and the prolonged public mistrust of science has left you demoralized and questioning your purpose.

In this setting of battered morale, it is sometimes challenging to find the joy in neurology and remember why we chose this profession. I recently read an advance copy of A Molecule Away from Madness: Tales of the Hijacked Brain, which will be released this month, and I was reminded of the excitement that I felt during training, a feeling that I still have when a new neurologic discovery is made or when I arrive at a difficult diagnosis which helps a patient. I had planned to read a chapter or two each evening, but the author, neurologist Sara Manning Peskin, MD, MS, so compellingly captured the mysteries of the brain and the thrill of the underlying neuroscience that I stayed up late into the night to get to the end. Not since Oliver Sacks has a writer moved me to such extent or made me so proud of the history of our profession. If you have not yet read her work in the New York Times about human fallibility or about dying, I also recommend those compositions highly. I have invited her to speak with me about her book at a HeadTalks presentation in Seattle, and I am certain you will hear more from her in the years to come. It will be the debut of Orly’s Book Club, in which I hope to feature other authors in future meetings.

I also found joy in a little book that came my way earlier this week. Neurology in a Nutshell, written by two adult children of neurologist Taimur Zaman, MD, explains neurology to children in a fun and engaging way. In this paperback, neurologists are depicted as mystery-solving detectives on the hunt for bandits lurking in the nervous system. The captioned illustrations are sure to make you smile, regardless of your age.

Of course, the ties that bind us are much more than books. We are bound by a desire to get together in settings like the Great Neuro Reunion and exchange ideas, learn, and brainstorm side-by-side. During our last in-person Annual Meeting in 2019, I interviewed medical students who had received scholarships to attend the meeting in Philadelphia; speaking with them was one of the highlights of my trip. Several were deciding between a few specialties, but once there, they were quickly hooked. One commented, “Being surrounded by people from all over the world who have the same passion and who were so generous with their time was extraordinary!” Another summed it up by saying, “When you go through each specialty rotation in med school, they tell you to ask yourself, ‘Are these my people?’ and the answer which resonated loud and clear to me at the Pennsylvania Convention Center, was ‘Yes, these are my people.’”

It was at another of those Annual Meetings during business school when I attended a full-day course in practice management and suddenly realized what I wanted to do with my newfound knowledge. I later reached out to the speakers and inquired whether there could be room for me on the AAN Medical Economics Subcommittee. I, too, had found my people.

For this month of February—which celebrates love and the love of reading—I asked several colleagues who work with me on the AAN Board of Directors to share why they love neurology (and which is their favorite book that describes our field). I would love to hear from you, too.

Orly Avitzur, MD, MBA, FAAN
President, AAN
@OrlyA on Twitter

“Finding where you fit in medicine is crucial and neurology is definitely my home. Each week of hospital duty brings satisfaction of solving mysteries for some of our patients and families to allow them to progress and often the humbling experience that there will always be more to discover. My home is further defined by movement disorders and now palliative care. In the latter, I found the best of medicine—to see and hear my patients and their families and to help them with the spiritual struggles that illness often brings. My humble addition to Dr. Avitzur's list is The Five Invitations: Discovering What Death Can Teach Us About Living Fully, by Frank Ostaseski.”

— Janis Miyasaki, MD, MEd, FRCPC, FAAN, AAN Vice President

“I spend most of my time caring for patients with neuromuscular conditions that are progressive and debilitating and despite the emotional challenges of dealing with ‘terminal’ patients, I find that I am increasingly inspired by their innovation and resiliency. I am in love with neurology because I am in love with my patients and the lessons about life that they teach me. 'Carpe diem' has been my motto for many years as most of my ALS patients are now younger than I am. One of my favorite books is Tuesdays with Morrie which is the true story of Mitch Albom, a journalist, who provides an account of his former professor Morrie Schwartz’s anecdotes about life as he deals with an ALS diagnosis. Morrie reminds us that: ‘The way you get meaning into your life is to devote yourself to loving others, devote yourself to your community around you, and devote yourself to creating something that gives you purpose and meaning.’ Neurology is a career that provides me that purpose and meaning and the opportunity to make lives better.

— Carlayne E. Jackson, MD, FAAN, AAN President Elect

“I count myself as one of the ‘lucky ones’ who found a profession that has provided me with incredible challenges, opportunities, discovery, joy, sorrow, frustration as well as immense satisfaction since I began my journey in neurology four decades ago. As I sit down to write a few of my thoughts, I realized how easy it has been to get out of bed every day and care for those who present themselves to my clinic. They often have significant fears of what I might discover, but the humbling privilege of utilizing the knowledge I have accumulated through my training, reading, and experience in order to offer hope, solutions, and in some cases actual cures, cannot be undervalued. When I reflect on my day today, I began with answering the Neurology Question of the Day, enthusiastically discussing the results with my colleagues, then working through my schedule which included patients with cognitive afflictions (FTD, vascular dementia, AD), neuromuscular diseases (myasthenia gravis, cervical radiculopathy, small fiber neuropathy), CNS vasculitis, movement disorders (Parkinson’s disease, RLS) and a patient with Burning Mouth syndrome (for real). Such is the wonderful ‘box of chocolates’ schedule of a comprehensive community neurologist! I know I am with my tribe when walking down a hallway or attending a meeting sparks a discussion concerning the latest challenging case, recent article in neuroscience, or troubleshooting our EMR, coding and billing, or pre-cert woes. Another joy I share with my neuro-tribe is discussing recent books/articles we have come across concerning our field which have been thought provoking or life-affirming. Dr. Avitzur has called for suggested reading and I am currently finishing Whole Brain Living by Jill Bolte Taylor, PhD, a neuroanatomist who previously wrote My Stroke of Insight, a New York Times bestseller chronicling her personal journey after suffering an intracerebral hemorrhage. The book combines psychology and her understanding of the human brain to explain our perceptions, experiences, and behaviors. There are many other outstanding books which deal with the fascinating unknown of our nervous system and our calling as compassionate healers. When I started my career, I had a hunch that the neurologic discoveries and advances made in my lifetime would continue to hold my interest and add fuel to my love for our profession. I certainly have not been disappointed. Salute to our tribe!”

— James C. Stevens, MD, FAAN, AAN Immediate Past President