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Q&A


Dr Michael Flower, clinical research fellow and neurology registrar, UCL Institute of Neurology


What first attracted you to neurology? At school, while we understood precisely how the heart, lungs and guts work, I found the mysterious black box of the brain fascinating and exciting.


What do you enjoy most about the job? Every day I learn something new about how the nervous system works. You’d have thought that by now I’d have a fairly good understanding of how it goes wrong and how to fix it, but every day I see that we’re still a specialty in its infancy.


What do you find most challenging? Routinely, each day, I encounter situations where a mistake can have huge implications – maybe the patient would end up disabled, maybe worse. In other walks of life, maybe in other specialties, that happens occasionally, but working on the ward it’s several times a day. And because we have to work fast, we’re always exposed to this kind of risk.


Has anything surprised you about the specialty? Neurology is a big paradox. In one way it’s cutting edge, fast paced and highly academic, always pushing forward the limits of our understanding. On the other hand the clinical skills we use every day, and that are still at least as important, maybe more so than all the tests we can do, are rooted in hundreds of years of experience. A good neurologist learns from the past and the future.


What do you consider the most important attributes of a good neurologist? Logical thinking in the face of a huge amount of clinical information. Seeing the wood for the trees.


What are the most common misconceptions about your specialty? Neurology is more straightforward than people think. It can seem daunting at medical school, and maybe worse in foundation training, but you learn that with a clear understanding of basic neuroanatomy, a good history and a structured examination it makes much more sense.


says, are headache, weakness, tingling and dizziness. There are also a variety of rare diseases that can present a challenge to the diagnostic skills of even very experienced neurologists. This means that not all neurologists need to be alike. As the ABN says: “The skill mix for an academic neurologist working in motor neurone disease might be very different from that for a stroke neurologist running a hyperacute stroke unit,” adding: “But if your strengths include logical reasoning in the face of complex information, communication skills in difficult situations and psychological-mindedness then neurology might be the career for you.”


Sources • NHS careers - neurology: tinyurl.com/ycgf7t5v


• GMC neurology curriculum: tinyurl.com/ybd8n5nx • Association of British Neurologists: www.theabn.org


Describe a typical working week. Currently I’m doing a PhD in genetics and cell biology, so a lot of pipette work, cell culture and data crunching. However, on the wards my time is split between seeing referrals on the wards and in the emergency department (ED), going to general or specialist neurology clinics and learning from colleagues at departmental teaching.


What are the tools that you can’t live without in your day-to-day work? Communication skills and a logical mind. And maybe a tendon hammer.


Is there any advice you could give to a final year or FY trainee considering neurology? Try securing a rotation or taster session with a neurology department to make sure it’s for you. Maybe a quality improvement project to find out more about what we do. You don’t have to be the most academic trainee – a logical mind, enthusiasm for the specialty and good communication skills are the most important attributes.


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