When Dr Susan Steen was a resident, one of her colleagues said that being a neurologist is “treating the undiagnosable and diagnosing the untreatable.” She agrees that one of the main challenges of working within neurology is that there are many unknowns in neurology, though she finds it’s better than it was 36 years ago.
Dr. Steen was inspired to go into medicine by her anatomy professor in nursing school. She had been in nursing school for three years and was very interested in anatomy when her professor suggested she apply to go to medical school. This was in the 1970s, at the time that Title IX of the Education Amendments Act of 1972 had passed, which opened-up the door for women in collegiate athletics and in graduate school because schools were encouraged to provide better opportunities for women.
Dr. Steen originally planned to become a general surgeon until she met a professor of cognitive neurology named Kenneth Heilman. She fell in love with neurology, and Professor Heilman suggested that she become a neurologist. She decided to do her residency also at the University of Florida.
Dr. Steen started practicing medicine in 1983, before electronic health records or cell phones. It was the time of beepers and covering four different hospitals. As a young doctor, she made frequent hospital calls and soon began treating acute stroke patients, requiring her to spend more time in the hospital due to neurologic emergencies.
The healthcare landscape has drastically changed since Dr. Steen started practicing medicine, most notably the amount of control doctors have over the ability to take care of their patients. She believes this is primarily because of insurance and Medicare guidelines and restrictions on tests and medications that doctors can order. She also finds it challenging to spend quality time with her patients due to the number of administrative responsibilities that go along with practicing medicine today.
Dr. Steen believes that the biggest challenge that doctors face and will continue to face is the fact that they have a boss. She has been her own boss most of her career, so if she wants to see five patients a day or 30 patients a day, it’s her decision. But that’s not going to be the same call for every doctor; their hospital or their healthcare system is going to tell them how many patients a day to see and how much time they get to spend with the patients. Dr. Steen finds this to be very detrimental to healthcare as it puts a lot of pressure on physicians and detracts from their ability to appropriately take care of patients.
Dr. Steen feels that having the honor of being a physician is an amazing thing. She has developed her practice in a very intentional manner that has allowed her to spend the time required with her patients to be able to really listen to them, treat them, and connect with them as people. Being able to develop relationships with her patients quickly and in a deep way takes her above the everyday superficiality of life and this opportunity to have meaningful and trusting relationships with other human beings of all different walks of life is incredibly rewarding to
Dr. Steen loves hearing her patients’ stories and often some of their good jokes, too. Being an Alzheimer’s clinician, one of her missions is to discuss brain health with people and to have them understand the kind of lifestyle that’s important for a healthy brain; and to have them understand the risks that we all have of developing a degenerative dementia like Alzheimer’s disease and encourage people to be involved in clinical research for that disease.
On the other hand, Dr. Steen finds that things are more streamlined because of technological advances and neurohospitalists and stroke specialists that do a large part of the hospital work. She has been able to carve out a practice for herself doing mostly clinical work and outpatient work. This allows her to spend time with her patients, which is very important to her. She believes that in neurology, and in all aspects of medicine, communication is important, and being able to listen to patients takes time.
Technology in Dr. Steen’s area of specialty is a little different than in some other specialties when it comes to the patients. While her practice certainly uses phones and email and does have MyChart, many of her patients are older, demented, or cognitively impaired, so many of them do not utilize MyChart. The younger patients and the adult children of the older patients communicate frequently on MyChart. While she feels it’s never as good as face-to-face interaction, it does serve a great purpose in helping both the patient and their family. For example, if she has a patient with a family member who wants to tell her that their mother has been exhibiting some unusual behaviours, but finds it difficult to have that conversation in front of mom, because it will upset her, using this system, the family member can send Dr. Steen a note electronically in advance of the appointment.
Another great technological advance Dr. Steen appreciates is the use of teleneurology, which has provided her the ability to remotely diagnose patients and make it possible to begin their treatment quickly. She’s found this beneficial especially with her stroke patients because it has enabled her to provide tissue plasminogen activator (tPA) and other interventional modalities immediately. She’s seen some incredible successes with therapeutic modalities, particularly in diseases like multiple sclerosis, epilepsy, and stroke.
Dr. Steen’s area of focus is in neuro-degenerative disorders, including Parkinson’s disease and Alzheimer’s disease. What she finds most challenging is that Alzheimer’s disease is a terminal illness with no treatment, which is incredibly frustrating and sad. Dr. Steen is on the board of the regional Alzheimer’s Association, speaking on the association’s behalf and doing community talks about brain health and clinical trials, and often referring patients to participate in such trials.
While Dr. Steen has never practiced medicine anywhere else in the world, she has travelled extensively. Most recently, she was injured in the south of France and received very good care in a hospital there. However, she has been in other hospitals around the world that the experience wasn’t as great. She believes the incredible excellence of healthcare in the United States, and the opportunity for people to be treated is probably very much under appreciated. The cutting-edge treatment opportunities for diseases in neurology have been incredible, for which she feels fortunate.
Dr. Steen doesn’t think she’d ever want to switch to a different specialty. If anything, she might have a small family practice in a rural community in the mountains of North Carolina or Virginia or Colorado. She would do more practical things, some general surgery or mission work, and be more effective as a generalist and serve a more needy community.
The advice Dr. Steen would give to an intern is the same that she now tells her daughter, who is a fourth-year medical student: Just keep balanced. Have an open mind. Don’t be judgmental. Be kind. And listen.