Deep Brain Stimulation

Polishing up on the minutiae that is a part of this profession can be both stimulating and tedious. Stimulating to reaquaint oneself with the interesting rarities of disease and the beautiful anatomy that is the human nervous system. Tedious because much of that information is so rarely used and therefore difficult to store away for immediate retrieval. When one of those rare diseases present, one has ready access to volumes covering every possible aspect of the specific disorder. That coupled with a good residency in which one was exposed to all of the once-in-a-lifetime problems should be more than enough for one to make sound diagnoses and recommendations. But the Boards are not such a real world assessment. Or maybe they are.

When one talks to those who have both passed and failed the Boards, many different views are reported. Many say it is absolutely fair. Others disagree. Some relate sheer terror. It is likely that keeping one's head is at least as important as the knowledge base possessed. After all, you cannot even sit for the Oral Boards until you have been forged in the furnace of residency and passed a written test that can be equally as daunting. So no problem, right?

The fact that a general neurosurgeon sees just that, a general representation of surgical neurology is comforting. It gives one a broad knowledge base from which to start. Many 'super-specialists' only see a thin, albeit deep, slice of pathology. It would be petrifying to prepare for the oral boards if one had spent the last 3-4 years treating only a selected subset of neurologic pathology. However, because there are so many disease processes that are rarer than honest thieves, even a community neurosurgeon who treats a broad swath of neurologic 'badness' never sees it all again once out of training. And it is only by constant practice that one becomes facile enough to prove oneself before the group of very intelligent men and women sitting across the table.

All of that being said, reviewing my specialty is gratifying and humbling at once. Its been a while since I have reviewed DBS (deep brain stimulation). Its one of those surgical procedures mainly performed in tertiary medical centers but also a subject about which an examinee needs conversant. Then again, this whole process is a form of DBS in which this surgeon is also the patient.