Why we doctors need to be less scared of the brain

Taureef Mohammed

NEUROLOGY – the field of medicine that focuses on diseases of the brain – is the most feared specialty in all of medicine. The term neurophobia – the fear of neurology – is a real thing among trainees and was first used in a 1994 article published in the Journal of the American Medical Association.

A survey at the time showed that one in two medical students had neurophobia. Subsequent studies showed that non-neurology doctors and medical students reported the least confidence in diagnosing and managing neurological problems when compared to other medical problems, and ranked neurology as the most difficult speciality.

I am writing about this because I am at the midway mark of a one-month placement in neurology, working under the supervision of a neurologist, and I would be lying if I said I do not have neurophobia. On Friday, during a teaching session with other trainees, I felt it while looking at a particular powerpoint slide.

The slide was on frontotemporal dementia (FTD) – the type of dementia Bruce Willis has; the kind that Ian Black, the late UK Guardian reporter, had and which he wrote about in a 2022 article, “My brain is shrinking – and so is my world. Could I find out what’s wrong with me?” One of many different types of dementias, FTD can begin in many different ways and the disease can evolve in many different ways and they were all on that slide.

But this column is not about FTD or any other neurological disease.

More so, it is about the consequence of neurophobia. Fear of anything is bad – and potentially dangerous and damaging. Fear leads to avoidance and avoidance leads to a lack of understanding and before we know it we are trapped in a cycle of ignorance. In the end, we stigmatise: we push away what we don’t understand. (I saw the musical Hamilton a few days ago and I can’t get the line, “We push away what we can never understand,” out of my head.) And in medicine, a lack of understanding of a disease among healthcare professionals can push patients down a slippery slope toward therapeutic nihilism, the belief that nothing can be done to help the situation.

Now, back to dementia, a neurological disease. In a 2019 survey of 13,200 family doctors across 11 developed countries, 46 per cent, on average, reported having sufficient skills and experience to manage the needs of a patient with dementia. This is compared to 86 per cent who felt well-prepared to manage other chronic conditions. Of course, there are more factors involved – time constraints, lack of allied health services, lack of access to specialised dementia services – other than a lack of understanding of neurological diseases on the part of physicians.

But we can’t ignore the fact that a lack of understanding and stigma among us physicians exist. Indeed, there are several studies that show that we have pushed away people with dementia. And after two weeks on neurology, I can’t help but wonder how much of it is due to our fear of neurology, our fear of the brain, our tendency to look away from what makes us uncomfortable.

Let’s talk about another matter of the brain that makes us – physicians – uncomfortable: mental health. Some months ago, I attended a talk by a well-known psychiatrist specialised in physician wellness.

She described a situation where two physicians, employed in the same hospital, were admitted to that very same hospital, one with a heart attack and the other with depression. The physician on the cardiology ward was visited by his hospital colleagues who brought cards and flowers for their fallen compatriot. The physician on the psychiatry ward got no visitors, no flowers, no cards. After he was discharged, the physician who was admitted to cardiology confided in the psychiatrist, “I had the more noble disease.”

“Nowhere is the stigma of mental illness greater than within medicine,” the psychiatrist said.

The brain is complicated – yes. But the brain is also what makes us who we are, and disorders of the brain are the leading cause of disability worldwide. So, being afraid of the brain, looking away from it, is a problem. Twenty-first-century medicine makes us physicians believe that we can pick and choose the part of the human body that we like. When it comes to the brain, though, I am afraid we do not have a choice.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada