Neuro-what…?

Avoidance…

I love what I do for a living, but I can’t stand talking about it in mixed company. Neuromonitoring is a profession that very few people have ever heard of. It isn’t like other professions, the names of which spark an immediate understanding of responsibility and purpose. People just get what bankers and dentists do… Neuromonitoring on the other hand sparks blank stares, question marks, long bouts of blinking and the occasional inquiry, “Neuro-what?”

“Neuromonitoring. I evaluate the nervous system in order to preserve function during high risk surgical procedures of the brain and spine.”

Well… now we’ve moved from blank stares to wide eyes and open lips… “That’s so interesting! Do you work in surgery? Do you see patients? You shock them?!? Oh my God! Can you tell what’s wrong with my brain? Are you a surgeon? Do you know my surgeon? Do you watch Grey’s Anatomy? What do you think of Dr. Oz? My cousin has autism? My mom has a brain tumor? Is it true that we only use 10% of our brains? What do you think of gluten? How can I lose weight? Should I vaccinate my child? What color is the brain? What does it feeeeel like? Can you tell I’m histrionic?”

My goodness… can’t we talk about sports, travel and leisure. I just want to relax!

The problem isn’t the complexity of the field, per se, it is the fact that I don’t much like to monopolize conversation. I think other people are fascinating! So, given the opportunity, I’d much rather talk about them. This is a true story… When people ask me what I do for a living, I actually started telling them that I paint the black lines on basketballs. Everyone immediately understands the purpose of that profession, and, sadly, most people actually believe me. People just get it. The conversation ends, and we move on to something else.

I’ve stopped doing that now, primarily because I learned something really important: people need to know about neuromonitoring.

So many people out there in the world could benefit from neuromonitoring, and from knowledge about neuromonitoring, and yet they have few resources from which to learn. If you are going to have surgery, how are you supposed to know about the benefits of neuromonitoring unless your surgeon tells you? And, how often does that happen? Sure, there are lots of companies out there with information on their websites, but they all have something to sell. As a consumer, how do you know who to trust?

Acceptance…

I started talking about what I do for a living because I wanted people to be informed. I’ve seen people with paralyzed vocal cords from thyroid surgery because their surgeon didn’t use neuromonitoring. I’ve met people who have had cervical spine surgery and brainstem surgery without any neuromonitoring at all! I thought to myself, “Patients are taking more control of their healthcare now… What if they knew? What if they demanded neuromonitoring? Would it improve outcomes? Would the rogue cowboy surgeons finally be forced to listen?” I met so many people who, after hearing about what I do for a living, said, “I wish I had met you before my ______ surgery. Maybe I wouldn’t have this problem.” Maybe. No way to tell, but YES, you would have gone into the procedure with more knowledge and perhaps more control over the outcome!

After cycling between avoiding the conversation and actually talking to people and listening to their stories, I needed a way to reach the general public, to tell them about neuromonitoring and how it can help to reduce the risk of neurologic injury during surgery. I decided that the world needed another crappy website. So, I started this blog.

Transference…

Why stop there? Think about all of the people who work in and around surgery. Most of them have no idea what neuromonitoring is, even the ones who think they do! Surgeons, anesthesiologists, nurses and hospital administrators all need to understand neuromonitoring, and yet few have more than the most basic and frequently incorrect understanding of what neuromonitoring is (and what it isn’t). I met physicians who didn’t believe in neuromonitoring…I met surgeons who under-used neuromonitoring…I met nurses and hospital administrators that viewed neurophysiologists as pesky vendors, like we’re in the hospital to sell something…

I knew this problem wasn’t omnipresent, though. I had the privilege of working with surgeons, some of the best in the world, who deeply respect and rely very heavily upon neuromonitoring. I have worked with lots of people in various positions who understand and appreciate neuromonitoring.

My colleague, Dr. Adam Doan, and I once gave a presentation on IONM to a group of nurses. They asked us to talk for 3 hours….on a Saturday! That was a loooooong talk but, after it was over, the nurses kept us for an additional 2 hours asking question…on their day off!  They were interested, fascinated by IONM. So, I needed a way to reach people on the front lines of patient care and tell them about neuromonitoring and its benefits. Yes, the world needed another website!

Having identified the entire world as my target audience and the web as my medium, I needed a mission, a plan, a concept. What kinds of information would be included in the website? Should I get a fancy logo…a snappy catchphrase? What would I write about? How in depth should I go? What if I offended people? What if people argued? What if no one read…? What if everyone read? I can’t believe I’m starting a blog! Maybe I shouldn’t do this… Clearly the world doesn’t need another blog! Ha. That’s what goes through your head when you start a blog.

Beyond the desire to tell people all about neuromonitoring, I started a website/blog because I wanted to communicate and exchange ideas with people who share my passion for neuromonitoring. I wanted to create an online community… outside of facebook, LinkedIn, Twitter, etc. Sure, it’s great to belong to a professional society, like ASNM or ACNS, but blogs by definition are a little more informal, personal, intimate. People who work in neuromonitoring know what it is like to work in such a demanding field.  We work long hours, we give up holidays, we get called in the middle of the night, we drive long distances, we go for 8, 10, 12, 16 hours without food or backroom breaks, we get treated like garbage by hospital administrators, we make a real, meaningful impact on patients lives, and we get zero recognition…ever. When you work in such a demanding field, you make sacrifices to your family, your friends and your health. This website isn’t an outlet for bitching and complaining, but that may happen from time-to-time. Isn’t is nice to know that other people understand and appreciate your sacrifices, that they empathize…??

Emergence…

So, I’m here, you’re here. I hope you like what you see so far. This blog, this website, is for anyone who is curious about neuromonitoring (aka: IONM). If you want to learn about neuromonitoring, or better understand monitoring personnel, types of certifications and the vast range of clinician qualifications, check out the IONM menu above.

If you work in neuromonitoring, and you’re looking for literature, upcoming meetings,  courses & workshops, webinars, or you want to find a professional society to join, check out the Resources menu.

If you want to read about special topics in neuromonitoring, if you want to share your opinion, if you want to start arguments with strangers, or if you’re here because you finally reached the end of the internet, then check out my blog.

I plan to update posts approximately on a monthly basis.

I hope to blog about interesting cases, discuss new books & research articles, talk about my personal experiences, debunk myths, spark conversations, and otherwise cry and complain. Feel free to leave your comments, ask questions and make recommendations for anything from future posts to website upgrades. Just remember to keep it clean and professional.

Are you interested in writing? Want to have your opinion heard, your experience shared, your work featured? If you have a concept for column or an individual post, don’t just sit there…send me a message! Do you want to advertise an upcoming presentation, webinar, talk, poster, meeting, etc? Send me a message and I will include it on the website.

This is a community, a forum, dedicated entirely to the tiny niche world of intraoperative neurophysiological monitoring and mapping. You are most welcome to join, subscribe, contribute and keep coming back.

At this time (June, 2014), I’m still tweaking some features on the website. If you find any problems, dead links, etc. Feel free to let me know.

Thanks for reading!

22 thoughts on “Neuro-what…?

  • Reply Erin Ross June 19, 2014 at 10:33

    Congratulations Rich! Great site!

  • Reply Mattie Dalton June 19, 2014 at 13:37

    I love it! This was an awesome article!

  • Reply Josh June 19, 2014 at 14:02

    Hi Rich,
    My name’s Josh, I’ve been in the field for several years and now I’m VP of an IOM company in Israel
    .
    I relate to everything you said!
    The conversation part is really getting old and the lack of recognition by the hospitals is crazy. We were in a negotiation with a head of one of the biggest private hospitals here last week and he said we were a necessary and annoying expense, like air conditioning – YES! IOM and AC ARE THE SAME EXACT THING!!!

    I’ve got an MBA and worked outside of IOM for quiet a bit, particularly in BD and marketing and when I came back to the field my first inclination was to go on a national campaign to raise awareness of IOM to all patients out there. Then logic sank in that we actually work for the surgeon, not the patient and there’s nothing worse than being forced on a surgeon by a pushy patient.

    So I’m throwing the idea back to you – how does one raise awareness or stress the importance on IOM to the medical field form the inside?
    Right now there are 2 main tools – academic papers (yawn) and years and years of working together in order to build trust. Both are slow and work on too small a scale, in my view.

    In any case, good luck with the blog – I’m certainly going to read it and share it with my group.
    All the best,
    Josh.

    • Reply Richard Vogel June 19, 2014 at 20:54

      Hi Josh. Thanks for your thoughtful comment. Regarding your question about how to raise awareness and stress the importance of IOM to the medical field from the inside, I agree that it is a challenge. In some ways, it is a grassroots effort. It takes individuals at hospitals all around the world giving in-service presentations, grand rounds lectures, etc. It takes conversations with medical staff. It takes quality monitoring and building trust. On a larger scale, we need those academic research papers because we live in a world of evidence-based medicine and we need to demonstrate efficacy, not anecdotally, but scientifically. And, when those papers are published, we need to go to surgeons, anesthesiologists, etc and share those papers because most surgeons don’t ready our journals. The larger professional organizations, like the ASNM are working very diligently to provide the evidence and develop professional practice guidelines. I try to give presentations to our medical staff, and I share research findings with them, too. I’m always thinking of new research projects, but they can be challenging to get off the ground, especially if you aren’t a hospital employee. Also, I’m on the web…writing the blog. If people like what I write, they should share it, tweet it, like it. Word spreads quickly that way! Recently, I joined a couple of ASNM committees in an effort to get involved with the concerted effort to perform research, develop guidelines, engage surgeons/hospitals and educate the masses. If someone were to ask me, “What can I do?” I would tell them about all of those possibilities. Sadly, nothing happens overnight. It will take years of hard work, but I believe that we as individuals, and as a group, can make lots of progress. Thanks again for your comment!

  • Reply Dana Jedynak, CNIM June 19, 2014 at 14:44

    Richard,

    I love this article and I agree patient awareness must be a top priority for IOM as a field. Please let me know if I can aid in any of your efforts. I especially like the opening…”what do you do?” Neuromonitoring….blank state, everytime! Ha.

    Dana

    • Reply Richard Vogel June 19, 2014 at 20:35

      Thanks, Dana. Glad you liked the article! More to come…

  • Reply Barry Haitoff June 19, 2014 at 15:35

    Great read! Looking forward to future posts.

    Barry

  • Reply Skylar Matteson June 19, 2014 at 19:16

    Love the site. Great Idea!

  • Reply Joe Khoury June 19, 2014 at 21:20

    Love it! Keep up the good work.

    Best,
    Joe

  • Reply Greg June 23, 2014 at 09:43

    Rich:
    This is very interesting. As I plan on going into Hospital Administration when I retire in two years this has sparked an interest as prior to this I must say I have never heard of it. I am interested in reading more about this topic thank you for bringing it to my attention.

  • Reply Richard Slepian June 23, 2014 at 13:54

    Richard,

    I read your blog announcing the Intraoperative Neuromonitoring website and the reason why you created it. I agree that there is a need to educate the public, hospital administrators, IONM professionals and surgeons. Great job defining IONM and credentials of the various professionals that provide the service. I am the co-founder and past president of a monitoring company called ORIMtec located in Sacramento, CA. Prior to the sale of the company in 2011 we created a website that in addition to promoting our services acted as a resource for IONM professionals and information on IONM for those mentioned above. Our purpose was for many of the same reasons you mentioned in your blog, education. You may find some ideas to add to your website by visiting orimtec.com. Please understand that several of the buttons no longer function as we, the past owners of ORIMtec, no longer have control over the website.

    The home page still displays the name ORIMtec but other pages display Quantum Neuro. You will get a good idea of the resources we offered just the same.

    The ORIMtec Advantage still exists and is where we explain the value of IONM to surgeons, patients and hospital administrators.

    The Illustrations button still functions and is a great resource for neurotechnologists.

    The CEUs button no longer functions. It contained online classes directed at our approach to technologist education which centered around navigating the OR, surgical procedures and surgical instruments as defined in The ORIMtec Approach under the ORIMtec Advantage button.

    Surgical Animations no longer functions. We licensed the animations from Swarm Interactive and also had an animation created for IONM. If you click on the Surgical Animations button a phone number is displayed to contact somebody about licensing if interested.

    IOM Forum was our blog section. It is no longer available unfortunately.

    Potential Briefs still works but videos that are referenced do not work. Paging through the archives will provide some information on contents of the Potential Briefs newsletter.

    We also sold ad space hence the sponsors such as ASET, Cadwell, etc.

    The Neurotechnologist Reference Guide is no longer available either unfortunately. Over 1,000 copies were distributed.

    Hope you find some useful information. Please contact me if you have any questions or want additional information. I look forward to participating in your blog.

    • Reply Richard Vogel June 25, 2014 at 09:08

      Hi. Thanks so much for sending me this wealth of information. I haven’t had an opportunity to look through the website yet, but I definitely will.

  • Reply Justyna Lesniak June 27, 2014 at 13:14

    Rich so well written, enjoyed it immensely, thank you.

  • Reply Kristina Port MPA, R.EEG/EPT, RPSGT, CNIM July 7, 2014 at 13:40

    Thank you Richard for implementing a blog that is totally worthwhile. I wish you much success.

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