Being a neurologist involves so much more than being a “brain doctor” because it involves the care and treatment of various conditions across the whole neurological system, which makes the field ripe for various highly-niched specialization. One of these very specific niches is epileptology, which deals with the care of patients living with epilepsy and other seizure disorders. Madeline Fields, MD, MS excels in this sub-specialization as the Co-Director of the Mount Sinai Epilepsy Program. Joining Dr. Richard Marn on this episode, she discusses the various specialization areas for a neurologist, what being an epileptologist means, the key skills that neurologists and epileptologists need to succeed and some recommended resources and ideas for students interested in neurology and epileptology. She also shares some of the success stories that have further inspired her to persevere in this career path.

Listen to the podcast here:

Epileptology – A Highly Niched Subspecialization Within Neurology With Madeline Fields, MD, MS

That’s Dr. Madeline Fields, a neurologist and epileptologist. We’re going to learn about a special skill set that she has that few people in this world possess. We’re going to talk a bit more than just medicine.

Our guest on this episode is Dr. Madeline Fields. She is a Neurologist and Epileptologist. She works at Mount Sinai Hospital in New York City. She received her Bachelor of Science degree at SUNY Binghamton and went on to Terrell College to get a Master Science degree in Biological Sciences. She also got her MD degree at Technion Israel Institute of Technology. After that, she did her postdoctoral training at Albert Einstein College of Medicine for internship. She went on to Mount Sinai School of Medicine for her Neurology residency and completed her training at NYU where she did a Fellowship in Neurophysiology. She is Board Certified in Neurology, Clinical Neurophysiology and Epilepsy. During her training and career, she has earned many awards.

She has multiple pollsters and abstract presentations, published several articles in reputable medical journals and written a number of chapters for various books. She’s a frequent lecturer especially as it relates to epilepsy. She also has held several positions such as Fellowship Program Director for Neurophysiology and Neurology Residency Application Committee member. Dr. Madeline Fields is an expert in her field. She’s a wonderful person and it’s a pleasure to have her on this show. She’s an Academic Physician who specializes in Neurology and Epileptology. Let’s get to meet her. Welcome to the show, Dr. Fields. I am happy you’re here with us. How are you?

I am terrific. Thank you for inviting me. I am honored to be here.

Thank you. It is a pleasure to hear you, see you and be part of this with you. For our readers, Dr. Fields and I have gotten to know each other because she was caring for a dear friend of mine. I also happened to be present for at least one of those appointments with that friend. I can personally vouch that if I ever need a neurologist, you would be at the top of my list. No doubt but there’s so much I want to cover with you. As I found that you wear a number of hats, titles and have a number of experiences that I’m interested in. Let’s start with someone that doesn’t know you. What kind of doctor do you tell them that you are?

As a neurologist, to young people, I say I’m not a surgeon but a brain doctor. I usually say neurologist who specializes in seizure disorders.

For some people, they don’t know what a neurologist is or even seizures or what epileptologist is. When I met you, I didn’t know much about epileptology as well. Can you please describe what a neurologist and epileptologist is?

As neurologist isn’t just a brain doctor because it cares for the whole neurological system, which is the brain, spinal cord and peripheral nerves. What helps us to be who we are and how we feel, how we take in the environment and how we express ourselves in that environment. Caring for that system is what a neurologist does. All the different parts from the head to the toes is the neurologist. From headaches, stroke, neuropathies to other kinds of neurological conditions like multiple sclerosis, cancers that affect the brain. A neurologist helps to take care of all of those things. It’s an interesting job. An epileptologist or a seizure doctor is one that sub-specializes in people who have a little too much electricity or seizures. Most seizures particularly in adults are not the big convulsions that you see on TV. Sometimes they can be much subtler. Those are the things that I do specifically.

To be an epileptologist, which is a fancy word for seizure expert. As an epileptologist, do you have to be a neurologist to be one? You can’t be an epileptologist and not be a neurologist?

Correct, which is not always the case for other types of medical fields. For example, a pain doctor, someone who takes care of people who have a lot of physical pain can be an anesthesiologist, can be a neurologist, can be a physiatrist or rehab doctor that specializes in those things. Specifically to be an epileptologist and a lot of the subspecialties and not all but most in neurology you have to be a neurologist first.

As a neurologist, you can choose to go into other specialties as well besides epileptology? What are those other options for people that are thinking about neurology but want to go into something else besides being a seizure expert?

Listening to people’s stories helps clinicians learn and grow. Click To Tweet

A lot of people after they finish residency become general neurologists. It was much more common years ago, but still even now, people can become neurohospitalists which are neurologists that take care of patients in the hospital. When they come in, they would be a consultant for someone that gets admitted to a different service like medicine or surgery. If they have a neurological complaint while they’re in the hospital, a neurohospitalist would go and see them. That is a subspecialty. You can get fellowship training as a neurohospitalist but you can also apply for that job without any fellowship training.

To be a general neurologist, you don’t have to do any specialty training but then after neurology you can decide to do a fellowship. Those include things like stroke, headache or multiple sclerosis. Sometimes it’s not called MS, it’s neuroimmunology. When the immune system fights the neurologic system, you can become a peripheral neurologist. It’s a neurophysiologist that deals with everything basically from the neck down. I always think of myself as a central neurologist from the neck up. They can deal with conditions such as Guillain-Barre, all sorts of neurological conditions, Myasthenia Gravis. You can do neuroinfectious diseases. Sometimes people will get an infectious disease and it will affect their nervous system. Those are neurologists that deal with the complications from infectious diseases.

You could also become a strokologist, a stroke doctor. Even off of that there is a subspecialty called interventional neurology where people will do some training in stroke and then they learn to become an interventionalist which is procedure-based doing that from anesthesia. Being in the OR they can retrieve clots from stroke, do angiograms and they do a lot more invasive procedures. Neurointensivist is another subspecialty. People who work in the ICU but specifically neuro ICU and who come out of surgery for various brain issues, the neurointensivist deal with all the ventilators and all the complications and recovery from surgery or complications from neurology.

From neurology you can work as a neurologist and have a career as such but you can definitely branch out into many different facets of medicine that can take you to different places within the healthcare system, it sounds like. As an epileptologist, can you describe what your typical day is when you’re taking care of those patients?

My job entails a bit of inpatient work and outpatient work. A typical day would be I would wake up in the morning, head on into work. Maybe try to exercise before. Usually, the inpatient work comes in the morning. I get into work, I would read some EEGs usually with a fellow. EEG stands for electroencephalogram. Most people are familiar with EKG, which is looking at the electricity that naturally comes off of the heart. An EEG does the same thing. It just magnifies the brainwaves by a million times. I’d sit in the morning with a cup of coffee, a fellow, some EEGs and read the inpatient studies.

Patients who had come in with a seizure or to rule out for a seizure and who were connected to this machine for 24, 48, 72 hours or more. I read their overnight study and then go and round on them. I see them in the hospital with the neurologists or the intensivists. I see how they’re doing, feeling and help to manage their medications while they’re in the hospital. The medical team or the neurology team would continue to care for those patients during the day and then I head off to clinic in the afternoon. My clinic consists of seeing patients of all ages.

Even young children all the way to elderly patients?

Yes. On a given day, I might see a 3-year-old and a 90-year-old and everybody in between.

What’s the usual history of some of these patients or even an example of a patient that you saw?

Sometimes people come to see me for a first time seizure or what we say a rule out seizure. They may have had an episode that was strange, weird or something more dramatic where they convulsed and lost consciousness or just lost consciousness. They want to know. They may have told their primary care physician who then said, “You need to make sure this isn’t a seizure. Go see a seizure specialist.” Sometimes, the same patient might get referred to a general neurologist in their outpatient practice. That may be one type of patient that I would see.

A first time episode where someone lost consciousness and they may have shocked during the episode. Another type of patient is someone who has a history of seizures, has been tried on many medications and has continued to have seizures through those medications. They come to someone like me because I work at a center that has access to monitoring, a neurosurgeon if necessary and a nutritionist who could put them on a particular diet that’s good for seizures, what’s known as a comprehensive epilepsy center.

HCDM 7 | Epileptologist Career

Epileptologist Career: You have to be a neurologist first to niche down into epileptology or any other sub-specialization in neurology.

 

It is at Mount Sinai Hospital, which is where you work. Is there a particular patient that you took care of that left an impression on you especially someone that has epilepsy?

I can honestly say that every person leaves an impression on me. It is a job. It speaks to medicine probably in general where I have the honor of being able to listen to people’s stories. Every story leaves an impression on me, helps me to learn and grow from as a clinician. I can give an example of a case of a woman who had been seen at a different clinic for many years. She was seen by many different physicians who cycled through that clinic and was put on medication but had a hard time bonding with any one clinician because of the frequent turnover. She had a difficult time sticking with her medication. She had come to see me several years ago and over time we built up a relationship and a trust. She eventually underwent epilepsy surgery where she had a device placed in her head that helps to control the seizures. It’s a relationship. It’s had its ups and downs but she’s among all my special ladies. She has been able to have a job, which she was never able to have before.

She couldn’t have a job because of her condition?

Correct.

That could be depressing for some patients.

For some patients, it’s debilitating. The fear of having a seizure at an unpredictable time. The unpredictability of it is one of the things that makes it daunting and debilitating. In this particular woman, she was never able to have a job because her seizures were frequent. With better control she was able to get a job and work, which afforded her the ability to buy her kids presents and things that she couldn’t do before, which was a wonderful thing to experience and be a part of.

Is there any particular part of your job as a neurologist or epileptologist that you would say is your favorite part?

The patients are my favorite part.

Why is that?

I truly enjoy hearing from them and working with them. I’m trying to make it so that what I do falls as background noise into their lives and is not at the forefront, which it is certain most certainly at the onset of the illness. I can’t say for everyone it’s not true but the ability to watch that and to continue to work toward that with every patient I see is something that keeps me going and why I do all the other things. I dabble in the clinical research part and all that stuff is to try to think about and come up with ways to make it so the thing that I do goes into the back.

I’ve never heard it put that way. I feel that’s intriguing that perspective. Some people like to make sure people know that they took care of a patient and your approach is to help take care of someone and I may need to take care of them for a while but that you are the background to their life. That’s deep. Is there anything about your job and your career that maybe is a little bit on the mundane part or not exciting part that is part and parcel to what you do, unique to your specialty?

Being a good listener and attention to detail are helpful characteristics to have as a neurologist. Click To Tweet

I don’t think it’s unique to my specialty but I hate making a schedule. Some of the administrative duties, it’s something I’m not good at. I tend not to gravitate toward it. Be in charge of who is where, when, on call and all those things or when people want vacation. I’m trying to look at it these days as a challenge and not like a thorn in my side. It comes with some of these administrative duties that are difficult and I think it helps me to be a better organizer, timekeeper and things that are more challenging for me and my personality in general. When it works, it’s wonderful. IT issues are not my favorite.

Are there any unique perks that maybe the typical person may not know about your career?

One of the reasons I became a seizure doctor is my one of my mentors had this wonderful office space. When I was a neurology resident running around, checking on this and checking on that. I would run into his office to see what an EEG showed and he would be sitting there drinking his coffee, listening to NPR. I was like, “That is amazing. I need that job.” It is not exactly what I do every day but there are moments where the ability to sit, interpret and study all these squiggly lines. To be able to do something and make sense of something that seems wild feels good. It feels nice to be able to make sense of it and as a result of that know what to do with it to a certain extent, how to treat it.

I’m a physician but EEGs are a foreign language to me. It’s a unique skillset. Would you agree that few people in this world have that you need specialized training for? A lot of us are trained to read an EKG, but an EEG, I look at it like a lot of squiggly lines. You also were inspired by this unique skill. That was somewhat attracted to you as well.

That is true. It’s this idea that you learn about the function of the brain, which is who we are. We can learn about who we are as people through dysfunction. When things don’t work and luckily in seizures it’s temporarily so the brain has a momentary dysfunction. You can learn about human beings that way and ourselves that way. I didn’t come at it from an engineering background, which a certain number of people do but I’m liking circuitry which is what an EEG is. The interpretation of something which seems enigmatic is an interesting task and something that naturally comes out of the body to be able to see it and make sense of it is an interesting job.

Are there any particular skills, qualities or even a certain mindset that you think your colleagues in your career best flourish?

Attention to detail helps. It doesn’t mean you have to have it but it does help with interpretation, with reporting of the EEG and in in taking care of the patients. Not EEG in general but particular to what I do, not necessarily medicine in general but to neurology and epileptology, listening to the patients. Being a good listener because people usually tell you the story. You have to be able to hear it. Being a good listener and attention to detail are helpful characteristics to have.

How did you even get into epileptology in the first place?

I knew myself that I like inpatient and outpatient work. That combination of being able to sit in a clinic and see patients but also to be able to take care of patients when they’re in the hospital. When they come in electively as well as when they come in urgently and intensively. Being able to take care of people when they’re having seizures that are unrelenting and maybe even resulting in being in a coma. All stages of the spectrum like all ages, there’s something nice about being able to take care of healthy people, sick people, inpatients and outpatients. That mash up of being able to mix it up and change the focus depending upon where I’m at in my career but so far, I’ve always done the same thing. It’s a mix up of it all. It keeps it interesting.

Is your work life balance as a neurologist and epileptologist good? Does your job require you a lot of sleepless nights? What is your work life balance for people that might be interested in this career? How would you describe it?

It’s a work in progress. It’s sad because I’ve been doing it for so long. I’m a mom. I have three kids. Things have been turned upside down but making or creating a time for things is a skill. Doing it well is also a skill I’m looking to develop better. Sleep sometimes does get sacrificed as a result of that but there hasn’t been a night that I have been up all night and not for many years. It is a balance that I’m still working on but I do have time to enjoy my family. My eldest daughter who’s twelve was repulsed by medicine for many years started watching Grey’s Anatomy and now decided that she wants to be a doctor. I’m doing it. I don’t know if I’m doing it. There is a life work thing going on.

HCDM 7 | Epileptologist Career

Epileptologist Career: The brain is who we are. We learn a lot about who we are as human beings through dysfunction.

 

As a woman, as a physician, as a mother and a spouse, it’s not easy to balance all those demands especially someone with a unique skillset like you have. I would imagine that would be sometimes challenging.

Definitely. When I started out, I was fortunate to have met a colleague who was in a similar situation to me and had young kids. We job shared in the beginning. When we both had young kids, she would work three days, I would work three days and we would work every other weekend. We would split it. Being in it with someone who was in a similar situation got me through those early years of work. It didn’t hurt to be able to get up early in the morning before life gets started and get some things done before then, which is how things are now in the wee hours of the morning or in the late hours of night. We did that for many years. After a while things got busier, our kids got bigger. It was always a full-time job working the weekends, the weekdays and splitting it up. We did get to spend time at home with our kids so I feel fortunate to have had that early on.

That’s a great story. Thanks for sharing.

I also had an incredibly supportive chairperson at the time. It sounds silly at the time but I was almost afraid to ask for it. One thing I’ve learned over the years, if you don’t ask, no one is going to give it to you. I went in there and I was like, “This is what I would like to do.” He was overwhelmingly kind and supportive. He was like, “That sounds terrific. I couldn’t have imagined what my kids would have been like had my wife not been home.” People understand that he was a man and he got it. Anything is possible. I wouldn’t let the idea of having a family and a life outside of medicine preclude a career. It’s because I think there are many versions of how this job and this life can play out. I know other colleagues who did more research early on so they would have a regulated 9:00 to 5:00 schedule, no calls, no weekends. There are ways to do it or had three days of clinics a week, packed it in. Different iterations for sure.

I want to get to how you got even into neurology. Was this something that you wanted to do when you were a child? Did you want to be a doctor when you were in high school?

Thinking back, I don’t think I knew necessarily what I wanted to be. When I got into college, I wanted to be almost everything that whatever subject I was taking and liked at the time, I was like, “I’m going to do that.” I did go in with some sense of this as a possibility.

A neurologist?

Not a neurologist, just as a doctor. I did like science. My father was a dentist and he had been a big fan of medical careers growing up. He was a proponent of keeping your options open. I appreciate that but not everybody has that. I changed my mind 50 times when I was in college but I did. The neurology part came in medical school. I had a teacher who could draw the brain and the spinal cord. He was ambidextrous with both his right and left hand at the same time.

He’s drawing with two hands on the chalkboard the brain, spinal column and all the other accessories.

He took half the time as it would any other human being and I was like, “If I become a neurologist, I bet I can do that too.”

That was your first idea that you might be a neurologist because of this this person.

It’s an honor to have a job as a neurologist. It has a multitude of facets which make it interesting. It’s a good life. Click To Tweet

Yes, he was awesome. I loved what he said. It was it was interesting to me and he was an interesting character. That helped. Even before I did the clinical stuff, I had this idea that that’s what I would do.

Reflecting back, is there anything that you would do differently?

I dream of this sometimes. I hadn’t gotten my PhD.

PhD in what?

An MD PhD in some field of neurology. Specific to me now, it would be epileptology.

What would the PhD allow you to do or provide you that you don’t think you would have gotten as an MD?

As a PhD and I do have colleagues who are not MD PhDs who do get to live a life of an MD PhD. It means to some extent, they get protected time for research. Maybe not now but maybe when I’m 70 and I still want to work but probably shouldn’t. It’d be nice to go to a lab somewhere where no one could find me. Knowledge and education does help one to critically think about research, which is a little new to my hobby, but have a lab or be able to test hypotheses. Not by necessarily looking up other people’s work but by doing your own.

I mainly do clinical research and that is extraordinarily rewarding. If I wanted to get more down to the nuts and bolts of how things work, a PhD would help with that. I have a lot of colleagues now who while they’re practicing clinicians, they go and they get their Master’s to be able to critically look at a manuscript and say why it is junk or if it’s fantastic. To be able to have a sense of statistics and things that are useful when you’re reading. Those things back in the day weren’t necessarily required. Even a Master’s or PhD can be a wonderful way to complement what you’re doing at some point in your career. Usually early on, people who do have their PhD tend to do 80% research and 20% clinical, which is not something I was interested at the time as I get older and grayer.

What resources do you recommend for someone that might be interested in learning more about your career?

That’s such a good question. Your podcast series.

Thank you.

What you’re doing is incredible because I didn’t have anything remotely like this. When I was a college student, I made a point to volunteer in one of the local physicians’ offices. I called up a bunch and I said, “Can I see what your what your day is like, what your life is like to get a sense of what that was?” I do have a bunch of some high school students even and definitely some college students who reached out to me via email or a colleague that knows them. The associations that I am familiar with, the American Academy of Neurology, AAN, or the American Neurological Association, the ANA, are two wonderful organizations that are the mainstays of neurological research and neurology in general. They’re certainly more geared toward fellows, residents and attendings to get a sense of what’s out there.

HCDM 7 | Epileptologist Career

Epileptologist Career: The American Academy of Neurology and the American Neurological Association are two wonderful organizations that are the mainstays of neurological research and neurology in general.

 

Probably everyone over the course of their lives will certainly have someone who is affected by a neurological illness, which reminds me of another subspecialty which is cognitive neurology which is memory disorders like people who have Alzheimer’s or frontal lobe dementia. People, themselves with headaches or family members with neurological conditions. Each of the subspecialties of neurology do have their own organization like the American Headache Association, for me it’s the American Epilepsy Society. Even each of our subspecialties have a sub specialty organization.

There is at Mount Sinai though once a year a Brain Fair that is run by The Friedman Brain Institute, the FBI, which is part of Sinai. They have a wonderful Brain Fair where they have a real live brain that you can walkthrough. The neurosurgeons bring out their 3D printer and they get the brains that you can hold. We do an EEG on some of the students as they come by. That is geared toward high school students.

What part of the year is that usually?

I feel like in the fall but I’m not entirely sure. It is something that that takes place every year and it’s a wonderful opportunity and that is specifically geared toward high school students to try to get an interest in the brain.

How has your industry changed from what it was pre-COVID, say January and before, to what it is now? What changes and challenges in your career do you foresee in 1, 3, 10 years from now in your career?

What we’re doing a lot of which we essentially did little to none of before is these video visits. It’s through a secure chat but we have visits with both new and established patients. It has been wonderful in some ways, patients who wouldn’t even have access before or would miss appointments due to various reasons. We get to pin down and see how they’re doing and communicate with them in a way that we didn’t before. That has been wonderful in some respects. The pandemic has certainly allowed us to deliver medical care in a different way that is accessible to a number of people.

Are there any parting thoughts for students with or even anybody interested in your career?

Going back to changing the idea of what I wanted to be 50 times, it was the charm. I do get to be the English major. I do get to write through my hobby of research. I do get to be the scientist by looking at data and being able to analyze it. I do get to be the doctor. I do get to have that patient contact that is a is a wonderful thing. I do get to be the teacher. I have medical students and fellows. My job has afforded me those 50 jobs or those 50 ideas. It does keep changing and that ability to morph to some extent what I do as a neurologist. I get to work with neurosurgeons. I get to go into the OR but I don’t I don’t have to do the cutting. I get to see and be a part of many different or what might be thought of as independent or separate jobs every day. My parting thought Is that it’s an honor to have this job and it’s got a multitude of facets which make it fascinating. It’s a good way to wake up every morning. It’s a good life.

That was Dr. Madeline Fields, a neurologist and epileptologist that works at Mount Sinai Hospital. If you want to reach out to her, you can reach her at her work email Madeline.Fields@MSSM.edu. If you haven’t noticed, a number of people have an affiliation or worked for Mount Sinai Hospital, such as Dr. Madeline Fields. That’s because I used to work for Mount Sinai for almost eleven years. A lot of great people happen to work at Mount Sinai. I’m fortunate that they are on this show and I’ve been able to get to know them. Some other guests have been or have an affiliation with Mount Sinai or worked for Mount Sinai is Dr. Yolanda Tun, Jason Jackson and Tamiesha Frempong, all who have episodes on this show already.

In our next episode, I have an old classmate of mine who is a hand surgeon and he works in Oregon. He is a great guy and I’m fortunate that he is on this show. He’ll talk about his role as a hand surgeon but also his non-traditional path of how he got into medical school. He has an interesting background. Hopefully you’ll be able to read it and I look forward to serving you another wonderful episode. Hopefully, each episode gets a little better each time. Thank you for reading.

Important Links:

About Madeline Fields, MD, MS

Position: ASSOCIATE PROFESSOR | Neurology

Specialty: Neurology

Language: English

Hospital Affiliations: Mount Sinai Queens, Mount Sinai Morningside, and Mount Sinai West The Mount Sinai Hospital

Phone: Mount Sinai Doctors Faculty Practice 212-241-2627, Mount Sinai Doctors Faculty Practice 212-241-2627