Neurology Beyond Borders: Germany

From his office in Cologne late at night, Dr. Lukas Hensel walks us through what neurology in Germany really looks like on the ground, especially inside a university hospital where stroke, ICU-level decisions, and rare diagnoses show up disproportionately often.

We follow his path into medicine and the “brain as a map” mindset that pulled him toward neurology, then zoom out to the structure of German neurology training. He explains a mentor-driven approach to specialization, the sharp divide between outpatient neurology and inpatient academic centers, and why protected research time can be both possible and precarious depending on staffing and grant funding. If you’re curious about academic neurology careers, acute stroke care, and neurologic intensive care medicine, his day-to-day description is as practical as it is honest.

The conversation also gets clinical: the dominant stroke risk profile in a Western aging population, the rising mix of vascular injury with neurodegenerative disease, and the steady presence of inflammatory conditions like multiple sclerosis. Dr. Hensel shares a standout interdisciplinary case where persistence, repeat biopsy, and tight coordination across services changed the trajectory for a patient with recurrent embolic events. We close with what he wants next for German healthcare and neurology: more effective rehabilitation, smarter use of digital markers, earlier prevention, and clearer end-of-life communication so treatment matches patient values.

Subscribe for more global neurology conversations, share this with a colleague, and leave a review if it helped you think differently. What part of the German neurology system would you want to borrow or change first?

Transcript

SPEAKER_01 0:12

Welcome back to the Neurophilia Podcast, a medical education podcast dedicated to dispelling neurophobia one conversation at a time. I'm your host, Dr. Newper Goyle. This season we're taking neurophilia beyond borders. Today we are exploring a country known for its innovation, classical music, and distinct culinary scenes. We are talking about neurology in Germany. We are so honored to be joined by Dr. Lucas Hensel, who will share his path into neurology and the lessons that he believes neurologists everywhere can learn from Germany. Lucas, thank you so much for joining us on the Neurophilia Podcast. We're so grateful to have the chance to talk with you as this is a conversation in many months.

SPEAKER_00 0:55

Thank you very much for having me, Nupa.

Calling From Cologne At Night

SPEAKER_01 0:57

Of course. We always like to ask during um this season because people have been calling in from such interesting parts from around the globe. Where are you calling in from? What time is it over there? How's the weather?

SPEAKER_00 1:11

So actually, uh I'm in Cologne here in my office. I went here at around 10 p.m. now. The weather is very mild. It feels like a summer night out. The weather forecast says that it might drop to some colder degrees around like I don't know, uh 14 Celsius. But right now it's much milder. It feels like a summer night. And I'm uh I went to my office because at home the kids uh need to sleep, and I don't want to uh have them uh listen to the podcast already now.

Why Neurology Felt Like Mapping

SPEAKER_01 1:46

Yeah, they well they can listen to it when it's released, but um so grateful for you to be making time out of your busy day and night to be here. Um the way that we like to start all of these conversations is getting a sense of what inspired you to go into the field of neurology and sort of walk us through your career path to where you are today. So do you mind walking us through that entire process?

SPEAKER_00 2:08

Of course. Um actually, I I don't I didn't have the idea of going towards medicine. I didn't have many role models as a younger kid, I think. So I had the typical ideas of doing some big discovery. Like I thought about being an astronaut, uh treasure hunter, detective, and I'm I'm a very visual person. So I think one thing I always uh wanted to do is draw a map of things and uh like study a map of the crime theme or have a coordinate system uh with the planets. And I think it was in school already that we learned some part about the brain, and we noticed that there are these modules and this map kind of. I think it's one organ which really has a very interesting anatomy and a very interesting map and a lot to discover. So I found a lot of things already in school, which came back in the when studying medicine, and also when I did my uh doctoral thesis in an institute uh in Jülich, there's a research center, and they actually try to remap the broadman areas and uh spend a lot of time thinking about the different specializations that are happening in the brain. So that was a moment where I thought this is this is it. I want to take that knowledge and uh try to get more of it and bring it also to the patient because I think it's still with all the apparatus medicine we have, being a neurologist still means you do a lot of mapping before you actually come to a conclusion. It's very logical. You can have many symptoms that to other disciplines might appear like you all if if you are asked to come as a neurologist to the bedside. A lot of people will ask you, there's this weird patient. And then you come there and say, it's not weird at all. Like he's having very specific science, and and you can already guess at which parts of the brain that uh that uh pathology is happening. So I like that a lot. And and it's still what what uh gives a big reward from the day-to-day uh experience in the clinic.

Training Path And Mentor System

SPEAKER_01 4:22

Yeah, well, that's that is so cool. And I don't think I've ever um heard someone describe like their love or origin for neurophilia come from an early look for mapping, but it makes a lot of sense when you describe it that way. Um, you know, I'm wondering, and this kind of leads into our next conversation about um the training structure in in Germany. So, like how how did it go for you from your early maybe interest in mapping in neurology to becoming a full-fledged neurologist? Like, what does that training process look like? You know, how did you get to to what you do today? And are you are you specialized? Are you generalized? We'd love to know.

SPEAKER_00 4:59

So I think compared to other neurologists in Germany, I have focused very much on the pathway in the university clinic. I barely worked out of that uh field. Uh, for example, I've never worked in a neurology practice. And Germany has a very uh it's a very split system between the outpatients and the clinical setting. So I'm a neurologist with a lot of experience in the acute setting, uh in a specialized clinic in university, uh, in contact with research. But I always have to make up my mind what a general practitioner thinks or what a neurologist uh which uh or with less time uh maybe also, but with a more frequent uh contact with the patients will make out of my recommendations. So that is the other world in neurology that I have seen less. Um and we well, I would say the the training structure is built up in a way that in the university we see a lot of rare cases, uh, disproportionately much. And there are other fields like somebody who does her training in a practice will see the more frequent uh cases, but might refer patients when I think it's getting interesting with certain disease, and then I take care of it, but these people will read up on it when the patients come back. So um, what I think about the system in Germany is that uh the specialization takes place not in a structured way, maybe like in the US, but more on a mentor-based system. You're looking into who's teaching me this well enough. You I think that's a big responsibility you have to uh do on your own, looking out for a mentor. And of course, there are tests and exams for for the neurology um specialization. Um, I I did this exam in 2024, and then I did another um specialty in uh ICU. So as a neurologist, you can do an add-on in ICU uh neurologisch intensive medicine, it's called in Germany. So that uh requires you to spend uh more than a year of uh intensive care also uh doing trachostrachostomia or um uh managing uh extra ventricular drainages, so uh dealing with patients in a in a very critical setting. And I think what I noticed uh stroke and acute medicine is part of what I like very much. Uh I specialize more into this field, but of course, that makes me uh also very specialized in that direction and won't let me uh basically I don't want to step out of that or go into the outpatient sector that much anymore.

SPEAKER_01 8:14

It makes a lot of sense, and uh it brings up a couple questions. Um, the first one being um from like the time that you were in school to then getting through residency and um you know your your sub-specialization in ICU acute management, how long was that process from start to finish?

SPEAKER_00 8:32

So I finished um university. Uh university in Germany takes about uh six years. It's structured in a pre-clinical part uh of two years, and after that there are clinical rotations, and the final year is a year which has uh a general uh trunk, uh, but then also um some months that you can choose in your uh special interests. So, of course, I took the four months of neurology and I uh heard that in London uh there is a really good clinic where uh the European neurologist basic or neurology was uh partly defined. So I went to the Queen Square Hospital and saw how they would uh yeah, how they would discuss cases and and also I found my uh basically I found out that I really like the sub-specialization uh and working in a field where there are a lot of specialists and you can communicate a lot, but you always know you might not be the one super specialist in everything. So um um this the studies take six years, and then you do your final exam and you become licensed as a doctor. So from then on, you can work as a doctor in Germany, but you cannot open your own practice or you cannot become a senior consultant. For this, you need the specialization, uh specialization of neurology, and this requires you to do another um rotation in the clinics uh or part clinic, part outpatients. Um and it's there from this time took me, I think, above average because I combined it with research. Um I did my exam in 2014 and 25 was my specialization. So that was around 10 years.

SPEAKER_01 10:32

No, that makes a lot of sense. And so um, another question I have is um you mentioned that you are are subspecialized in in ICU and acute management. Is that typical in Germany? Because does it sort of matter where you are within Germany itself if you're in a much more urban area? Do you see a lot more sub-specialization versus if you're in a more rural area, you have more general neurologists? Like what are what are neurologists in Germany typically practicing like?

SPEAKER_00 10:59

Yeah, I mean, I haven't been out to rural areas that much, so I might be wrong about some things there. I think neurology is something where most people are seeking uh more uh dense areas. So I think many rural areas have connections or networks uh connected to the closest um center. And I also think Germany is a country with a very uh dense infrastructure. So I think most people who want to do neurology will find themselves in cities, and most patients looking for neurologists will travel to cities because the cities aren't far away in Germany. But uh what's probably also interesting is that some neurologists like the setting outside the clinic more, outside the acute setting more, and of course, there are clinics who do that as well. Certain rehabilitation clinics who don't do the uh ventilations or um or also the outpatient uh setting is, I think, also a promising pathway. If if you basically, I think often a general practitioner might not cover the chronic management of diseases, also of young patients. So this can be rewarding as well, with all the treatments coming up. Um but I think also those uh careers are mostly in cities. That's my from my experience, or from people who left the the clinic here and uh are now very happy in in the outpatients uh sector, they are or in the in their own practice, they are mostly in Cologne or in the surrounding or in in some at least smaller cities.

SPEAKER_01 12:46

Can you walk us through like a week in the life of what kind of patients you're managing? What is sort of your split between the clinical and research? Like what does a day in the life, a week in the life look like for you?

SPEAKER_00 13:00

Uh so I think the the typical day in a in a university clinic in in Germany would start with a um with a radiology round, or with a basically in in COVID times. This used to be uh on a video call for a while, but we switched back recently to the real meeting, uh sitting there at eight o'clock and going through the um all the brain scans from the night and from the day before. And typically every everyone who gets mentioned gets a little very short story. You have to go through a lot of pictures, of course. Um I think that's very uh similar all over the world, I would guess. Once we've seen all the brain scans, um as an attending consultant, I would go to my ward, or sometimes there are two, if you depending on what you're covering, and then uh meet the patients, make concepts for the day. Um sometimes uh in in some cases you talk to other attending consultants from other wards if you want something to happen very quickly. And then um, I think the there is a certain uh art to see the patients thoroughly, do teaching. I think there is a lot of things that a lot of interests uh there. Uh do enough talking to the patients so they don't feel overlooked or also they they get informed well enough. The challenge of the morning is to to see patients, and on a normal ward, like on the stroke unit, this this would be around um 10, 11 patients, and on other wards, this can be up to 20. But then uh some especially in the rehabilitation setting, many patients stay there for more than a week, so it's also easier to uh to grasp the information uh compared to a stroke unit where many patients stay for one, two, three days. Uh so and uh the afternoon, we typically, this is not all over in Germany. Uh every clinic can handle this differently, but in our clinic we meet again uh at around three and uh talk about the results of the day, and sometimes uh uh some some new insights came up from lab results or from the amnesis. Some sometimes uh some people from the family came up and and told a whole new story. So uh, and of course, we see new patients who came over the day. So it's the I think making room for research during that day can happen, but it rarely happens, and usually something urgent comes up, sometimes, especially on the stroke unit or in the ICU setting, there's an emergency emergency coming up or um some difficult situation where we meet again or come together. And of course, we have meetings during the day, like on Monday, there's a regular meeting for the entertaining consultants, then uh we have outpatients uh uh during the days. I definitely, if I want to do research, I need some nights where I uh or some evenings where I take my three hours and go into depth in some some sort of field or some question. But I find that it's become easier over the years because the literature gets more solidified and the specialization makes it a fun place to think.

Research Time And Funding Reality

SPEAKER_01 16:33

You know, uh a model that sort of is done here for our like ICU attendings is that they have like a week on or two weeks on and then a week off to sort of do research and other things. The way that you're describing it sounds very much like it's very clinical. You're you're very much on the wards all the time. And research feels like it's something you have to do in your own personal time. Is that an accurate reflection?

SPEAKER_00 16:55

That's in some cases, I think that's unfortunately the case, but there are, I think, more and more, especially in the university clinics, um there are programs where uh let's say 50% of the time gets uh freed from clinical routine, um, and or may mostly freed. So sometimes some um especially in research, uh in the clinical research, there might be always patients that uh that you will see, but it's true. There I think in the last decades there have been growing interest to enable clinicians to get time off. And as I said before, my training took longer because I I also profited from protected research time, and also now I'm I'm looking out for uh for options uh to get this time. And I think uh fortunately also in Cologne uh my colleagues and I have I have usually uh a perspective of having free weeks. But this is I think uh on the landscape in Germany, it's not uh I wouldn't take it for granted. That's something which is certainly special in some clinics who can afford that, who have also um many programs uh that are set up by the university itself, or uh have a more successful grant writing uh where with a lot of colleagues who have the resources by um uh the German Research Society, for example. So if if people get uh funding from Germany or Europe, like the European Research Council, or these kinds of uh funding, then it actually becomes uh much easier to get more free time. And I think this is fortunately also uh a place where I experience that. But it's it's irregular, I would say. It's not something that uh that I can always count on. And of course, if you have this time and in the clinic somebody uh gets a flu, you you will hop in. So I think that's also in in other fields maybe different, but in the clinical setting, uh the the clinical routine makes things more irregular, of course.

SPEAKER_01 19:24

Yeah, and and so you know, thinking about sort of like the last time that you were on quote unquote surface is the term that we use here, but um any like cases that stood out to you in particular, things that you manage that you find particularly interesting?

SPEAKER_00 19:43

I actually remember one patient, she was in her 50s, and she had uh a lot of uh thrombogenic events. Uh we found some kind of endocarditis, we didn't found any, uh didn't find any um specific germ. Uh like we thought about sepsis, but that wasn't the case. And then also the the information from the family added up that there was that there were ongoing uh events in the last months. Uh um an embolization of the lung uh was happening uh a month before. And of course, we like the the doubt comes up that there's some tumor or a malignant disease uh going on, but it's very uh in the in the stroke setting, I think it's difficult to find um to find the right priorities or also discuss it with other clinics because many people say, okay, that's a stroke now, the rehabilitation needs to come first. But if you have an ongoing malignant process, it can be critical to, in parallel to the rehabilitation, take care of the tumor properly. And I think also there uh there are a lot of good therapies at hand that I not know so much about as a neurologist. And we actually uh we ended up doing a tumor screening with a CT uh thorax and abdomen, and we found some lymph nodes. Then there was a biopsy taking of one lymph node, but it didn't really turn out to be uh very informative. And then we just went again. We we we stick to her, like we we really did a lot of calls with the others, uh, and we we made clear that we want to find out what this is, and we didn't want her to send her in a rehabilitation clinic. And we actually, by the by the second biopsy, uh we found um cells that were fitting a lung tumor that you could actually treat quite well. So she was before going to the rehabilitation clinic, she moved to the um internal uh clinic here as part of the hospital. So, of course, this is a very severe setting. But I think it's a typical um setup I I like about the acute setting that the problems that arise can be treated as urgent problems. And it's not something you always have to wait so long about. You can talk to other people on the same day, you get some appointment for the next day for a biopsy, and then one week later, you kind of solved something. Like it's it's a it's like a riddle or a case where I come back to my childhood memories where I want to be a detective, and that's actually uh something where I what I really like. And I also know that if you wouldn't put that kind of energy in that and the and uh talking to other colleagues from other fields who also start to like your case at some point, at first, of course, it's work, but then it's something we we all as I think as as medical uh doctors, we all kind of like this uh learning something from the other fields and then trying to commit to it as well. Um that is I think one of one of the cases where I found that the interdisciplinary work actually made a big difference in the course of treating the disease.

Common Diseases And Stroke Risks

SPEAKER_01 23:06

Yeah, that's that's so neat. And I think it's it's amazing how not only the collaboration was there, but also the efficiency at which you were able to like advance this patient's care is is truly wonderful. And I reflect on my own residency experience. And there's many times where patients have to wait days, weeks, even longer to get you know care. And so that part is really, really interesting. Um, uh something that I would I'm curious about, you know, it seems like a lot of what you're seeing is is stroke, um, especially in like the clinical setting. Are there certain um neurologic diseases, illnesses that you feel like you are treating or people in Germany are seeing a lot of, or specifically for stroke, is it one type of stroke uh etiology that you're seeing a lot of?

SPEAKER_00 23:58

I would say Germany is like most western industrialized countries, a country where we all probably eat not as healthy as we should. So um people get uh older, and I think blood pressure is managed quite well. Many things, when I look into the data also, I think the similarities also with North America that we like patients, especially in the city, like with Cologne, with a stimulating cultural program, with many um good general practitioners, like patients get old and they have a very nice standard of growing old. Like you actually look at patients and I think, okay, this is actually a nice way to imagine growing old and being able to do so many things, and then in this mix of uh risk factors of the like Western diet, uh society getting older vascular diseases, I think there is a risk profile that certainly defines most strokes, like in most uh I would for my gut feeling, I would say like 80% on the stroke ward are certainly cases where the solution is somewhere in managing LDL cholesterol better, uh blood pressure, um seeking out for uh cardiac problems like atrial fibrillation. I think that's very much of it. I would imagine it's similar in the US, I guess. Um in yeah, I think as I said, uh like younger strokes are more rare and more often also referred, of course, to bigger clinics if uh if if um but on the other hand, I mean uh the acute setting can make the referral also very variable. But sometimes uh patients um might be referred again or in the in the course of the disease uh later uh land in some outpatient's clinic. Um and then we start investigating it again. I think Germany has a lot of also genetic testing. I think Fabri uh or other um thrombogenic uh uh mutations. I think uh factor five, uh LIDE mutation or uh like protrombine uh mutations are commonly tested. I mean that's all things I think we're lucky to uh uh to do if we have younger patients. But the I think the average stroke patient is certainly uh older and there are typical risk factors. I think that's the day-to-day uh stroke patients we're seeing. And I think other other than that, uh I mean also connected with the age aspect is probably that we're seeing more and more neurodegenerative diseases, and they're all often mixed with vascular disorders. I think uh that is something I can always see the trouble in the one stroke somebody had. But if I have a neurodegenerative disease, which is focused on the parietal lobes or in the frontal lobes, and and that that mix it mixes with deficits that come from strategic stroke lesions, that can create a whole different picture. And uh and then a third uh very common group of patients in Germany, I think, are also inflammatory diseases. I think with a northern hemisphere country, Germany is also having a uh quite high proportion of multiple sclerosis uh patients from uh what I have learned about the vitamin D hypothesis, uh this kind of makes sense. Um, yeah, it's also very common uh diagnosis.

Outpatient Waits For MRI And CT

SPEAKER_01 28:00

Yeah, it's so interesting. And then, you know, uh thinking about sort of uh the outpatient um model, you know, something in our last episode with India, some uh a region in which there's like these hubs of where neurology care is available, and then the rest of rural India, there's sort of a scarcity. Even in that kind of model, patients are able to get outpatient CT scans and MRIs done within like 24 to 48 hours, which is something that we can only um fantasize about in the US. How does the outpatient sort of process look like in Germany?

SPEAKER_00 28:38

Yes, in Germany you wait a lot for an MRI and uh CT scan. And most people who go through the outpatients or practice sector, they uh typically wait a long time for seeing a neurologist. So many patients say, I have to wait two months. I think there are some uh practices. They offer early uh visits at around eight if you get into the line or something like this. So there might be always options, and there's also a way to call your insurance company and they kind of try to organize some neurologists for you. But typically for the MRI, you first see a neurologist, and that's already a barrier, like a barrier for many uh people. And then the MRI again is something you might wait uh oh yeah, some weeks or even a month. And in some cases, this is um, I think in some conditions it's not a problem. For some conditions, uh two months until the diagnosis is is okay. But some I think some people aren't managing it in a way that they're investing a time and calling some practices and then ending up with a diagnosis after two months. But many people will just look for themselves and after a while they will regret it, and they they will come to the ENA uh and to the hospital and and maybe uh try to to solve it because it has the symptoms have aggravated. But that is a I think a very common problem uh to the basically the yeah. On the one hand, Germany has a lot of MRI scanners and and a lot of capacity, but it's certainly not very efficient because some some patients get multiple MRIs for the same problem, and others are waiting, and then some people are just scanning the wrong body parts. Uh, like nausea is uh very common thing, is that people suspect something in their neck. I've seen patients with four scans on their necks, and uh it's yeah, there's no dizziness or nausea, mostly not coming from the neck. So, this is something where I think yeah, it could be more efficient because we have enough scanners and we have very dense infrastructure. But it also shows that just more physicians and more MRI scanners won't improve uh our health per se. We kind of need to make good decisions when we see a patient and decide like what part are we scanning or what what will help?

What Germany Could Improve Next

SPEAKER_01 31:23

Yeah, it's it's kind of a combination of resource availability but also clinician competency, right? Like you you need to, it's great when you have the resources and things can be done efficiently, but you have to be able to use your better judgment um when it comes to patient care. Um, are there you know common things about the way that the healthcare system is in Germany that you wish could be better or improved upon?

SPEAKER_00 31:51

Yes, of course, a lot of things could be better. But on the other hand, of course, it's always easy to have an idea. So I after seeing the closer I go uh towards a problem or some explanation, and the more you talk with people who've been dealing with it, the more of course I see that there should be some respect to the people who are managing the problem. So I if I if I'm focusing on the problems that I see, for example, um I would say that like there's the acute stroke setting and there's rehabilitation. I would say that we have a growing focus on the acute setting. And I think that's great. Um, I also like very much that neurology is drawing in more and more people who are like physicians that like to work in in a team of acute medicine and not on like a waiting and a very uh yeah, let's see what happened. And I just I mean, also I think there is a a way in all neurologists, there is kind of this interest in in the rare, uh uncommon thing. And of course, I I also like to uh to find the rare disease, but I think there's also the the part of us that needs some structured, efficient, and and uh also time timely decision making. And I think with a with a acute, with a growing uh focus on acute medicine, neurology can certainly learn from other fields who've been doing that for a longer time, and also neurologist trainees uh can profit from learning more about acute medicine. I think in many uh many neurologists learn a lot about the nerves, how to measure uh conduction between nerves, and and on the other hand, there are very like vascular, like a clot or like uh like a condition where there is a lot of uh clots going on through the whole body, not just in your brain, that you just saw in the on the on the MRI or CT, uh, needs us to understand like to have a much more acute knowledge in the internal medicine, like knowing something about uh uh ortisection or um yeah, like a disseminated uh plotting. And um I think in this this case, I think acute neurology should progress to be trained very well, but I think very much room for improvement will also be in the rehabilitation setting. I think this is a very um big field, and I think doctors are very many doctors I get to know have a rather conservative mindset. Like we study anatomy that never changes. We have a healthcare system where we are used to the fact that things change slowly, and also in the hospital, many of course, many decisions need to be made with a lot of other doctors and professors, and we I think we are adapting to a system that changes slow. And in many cases, that might preserve standards and it's good, but in some things, like when I see how much is possible with digital markers, we're all using cell phones, we have so many options to get a better insight into who is depressed after stroke, who like what are the limitations of rehabilitation? We can look at like body movements. Uh we can we have so much information at hand and so much possibility to to analyze this, but rehabilitation is still, I think, doing too little to really use this time window where people recover. So this is like my personal journey in in science, also. I think where I where I try to find some improvement that I can uh help make. And I think we're definitely not using all the resources efficiently that we could, like if I had a stroke and I would do the rehabilitation we have at hand right now, I think I would not be satisfied.

SPEAKER_01 36:15

And and so what do you hope in the next 10 to 15 years changes when it comes to the overall health care landscape within Germany when it comes to neurologic patients?

SPEAKER_00 36:31

That's a very good question. So concretely, I think um it would be really important, also because it the the costs are exploding. I think that's in many fields, and it might just happen on its own in some uncontrolled way. But it would be much nicer to be able to have some influence on how this is happening. But I think the resources, as far as I see it, go into directions where it's not always wanted. Like we have a a large part of the costs and resources are going into therapies that are at hand now, and uh, I think that's that's good. Neurology is uh take is it's becoming a very attractive field because we can do something, but of course, we have very many old patients and we have to communicate what we hope to do with these resources. Like many people are unfortunately spending their last hours in hospitals. The very recent statistics show that the imagination of the people is that they will uh sleep in their homes and not wake up. And many people also, if they're asked, they wish for a setting with their family, but they end up very in very many cases on an ICU board. And and in many cases, it's not really well communicated how uh how they would want uh this time to be. So the the sons and daughters will be at the bed and try to find some solution with the doctors what what the best wish could have been. And I think this is a uh typical scenario many clinicians know, and and we we have some so many machines and so much innovation, and we can uh we can use it in very different settings. And I think in this in this setting, it's something we cannot solve technologically. We need to solve this as a society, talking and making it more common to talk about this, and also I think maybe in school, like start very early to do prevention and um a traditional point, I think the last 15 years, neurology evolved from a field where we describe a lot of conditions to a field where we can treat a lot of conditions, but the conditions they have been always defined by a very bad state because one who goes to the neurologist in the 20th century is already lost, like that is very maybe a bit too dramatic. But that many people would want to become neurologists because the patient was so ill. And I think the next 15 years would be really nice if we don't see neurology or the diseases as a chronic condition or like a too late condition, but to research the time point, like we know in Parkinson's, it starts quite early. Like we we find a time where we can get the diagnosis and start to do prevention, or like based on I mean this is maybe just some fantasy, but if we had some data from apps or some, of course, privately secured, ethically on a high standard, collect data early, find something in a preventive sense, educating people about their neurological risk profile, which will pay back and make people actually want to find out more about themselves and talk about their states early and not wait until that point where you cannot talk anymore or where you cannot say anymore what you want to do. Because I think that's also much more fun for neurologists to um to protect people from that, what we often see today still.

What Makes Neurology Worth It

SPEAKER_01 40:23

I think that is beautifully said, and I think um a lot of people share your sentiment of the future of medicine becoming much more personalized and um high quality care for individuals and really thinking larger scale of what we do day in and day out, um, you know, to provide um individualized, personalized best care for patients and their loved ones. And so I think um I share your sentiments for a better healthcare system that really takes people's individual wants and desires um into consideration. Um, you know, I guess the last question that I have before we transition to no-brainers is, you know, what are you particularly interested in or excited about within the field of neurology? And that can be related to the incredible research that you're doing or other things that you're seeing right now within the landscape. But I'm curious to know, like, what really is making you excited right now to be a neurologist?

SPEAKER_00 41:24

So I think the most exciting thing about being a neurologist is that really every story a patient tells me, it's actually still important to listen to the story and translate very human, everyday setting into neurological function. And then draw back conclusions on the structure. Like as I said, I like the anatomy of the brain. There is, of course, the peripheral system. There's so much logic in how this is built up and to trace back the story that a patient tells me. Uh in every single case, it can be mixed with some, of course, some other organ systems, but basically, it's uh it's every time this is a lot of detective work. And I like to work with other people who are doing it for a long time, doing it for a short time. My experience is that it's not uh the point where somebody is in his 60s, a neurologist, and is like, oh, it's all easy for me. Uh you you might not get the story of the patient right, you might uh need to know more about the patient's culture. It's still it's a topic where you cannot have the one uh ultrasound and you already got it. So you have to have a good mix between communication logic, a reflex hammer. Is that something you can't just replace? I really like that. Maybe part of it is nostalgic, maybe uh part of it is um also this uh yeah, it's it's it's a lot of fun solving the riddle and actually knowing that this will make a difference for the patient now, uh, depending on the diagnosis and the treatment, uh, is very rewarding. And I think that's making the day go by very fast every every day in the clinical service.

No Brainers Rapid Fire

SPEAKER_01 43:14

You know, I uh Lucas, I I've been doing this podcast for for years, and it's it's always nice to, you know, at first talk to um, you know, attending physicians in my same state, somebody want to stay and not to talk to to you in a different country and hear the things that really make you excited about neurology and what you'd love to do day in and day out. It's it's amazing that even on a global stage, we can share such a love for the same topic and for the same type of patients that we get to treat. And so I don't know how this hour for by the way go, but I want to thank you so much for your time and for your experiences for being so honest and open about how healthcare was done in Germany. Um, you know, the last part of the interview is something known as our no brainers. Um These are going to be five rapid fire questions that you can respond to with one word or one sentence maximum. Okay. And so we'll start with the first one, we'll go through all five, and then we'll be wrapped up. You ready to go?

SPEAKER_00 44:13

I'm ready.

SPEAKER_01 44:14

Okay. First one is what was your favorite part of this conversation?

SPEAKER_00 44:23

I really like neurophilia and the way you connect the whole world with this interest.

SPEAKER_01 44:31

Oh, that's very sweet. Um, what is your favorite German food?

SPEAKER_00 44:38

Pizza, but not Germany.

SPEAKER_01 44:41

I was gonna wonder, I was like, is there a specific type of German pizza that I have not been aware of? Um if you could leave listeners with one message about neurology in Germany, what would it be?

SPEAKER_00 44:57

Look deeply.

SPEAKER_01 45:01

What is the most unexpected place you've ever thought about neurology?

SPEAKER_00 45:14

Unexpected place. You should ask me which place I didn't think of.

SPEAKER_01 45:28

The last question I have is what are you most proud of?

SPEAKER_00 45:34

My two boys and my wife. I think the family is the greatest achievement I have so far.

SPEAKER_01 45:47

Thank you for listening to this episode of the Neurophilia Podcast, and a huge thank you to our guests. We have many more exciting episodes planned for season four. See you in the next one.