The Veteran Neurologist: Q&A with Walter Bradley

by Aalok Mehta

October 8, 2009

In more than four decades as a working neurologist, Walter G. Bradley has seen it all. Not only is he a renowned expert on the gamut of diseases that affect the brain and nerves, he’s also edited the premiere textbook Neurology in Clinical Practice, taught hundreds of medical students and served as editor of several prominent research journals.

Now Bradley, emeritus chairman of neurology at the University of Miami’s Miller School of Medicine, has translated his expertise into print for the general public. In Treating the Brain: What the Best Doctors Know (Dana Press), Bradley clearly and concisely explains how the brain works and what happens when things go wrong, combining practical advice about diagnosis and treatment with stories of patients and families.

Walter G. Bradley, DM, FRCP - Portrait photo - FeatureIn this Q&A with Dana writer Aalok Mehta, Bradley explains why he thinks everyone should read this book the whole way through, why finding the right doctor is essential and how the Internet is changing the doctor-patient relationship.

AM: Why did you decide to write a book about brain diseases for a general audience— and why now?

WB: I’ve had 45 years in neurology, and I’ve always enjoyed trying to explain conditions in lay terms so patients can understand why they are suffering and what is going on. I get great satisfaction from that, and it really helps them deal with whatever is that they are dealing with—migraine, epilepsy, brain tumors, peripheral neuropathies, whatever. An informed patient is a much better patient, much better able to cope with their own condition.  That’s been one of the guiding themes of my career.

Another guiding theme is to explain to both medical students and the lay public the complexities of neuroscience and of research into both the normal function of the nervous system and its abnormal function in disease. These things are enormously complicated, yet their basic principles are relatively straightforward. With those basic principles, the lay public can understand what it means that somebody has apparently made this great breakthrough in a field that sounds so esoteric.

I greatly enjoy doing both those things, and I think I’m pretty good at it. Patients and my students have always said, “Boy that was so helpful, for the first time I came to understand what all this was about.” That gives me great satisfaction, and I know it helps advance the broader perspective of the field. I was coming toward the end of my time as chairman and I felt that I had some additional time to spend doing some of the things I like to do. So I said, “Let me write some chapters that will be of help both to the patients and the families who are dealing with this, but which will also be interesting for the layperson.”

I wrote this book with the idea that it would be read from one end to the other, not just by people who wanted to understand about the sort of condition they might be suffering from, but those who really wanted to read how the brain works, how it works when a player hits a 150-mile-per-hour tennis serve, how the balance mechanisms go off when somebody has a cerebellar degeneration, and so forth.

How you did decide to become a neurologist?

The most important decisions in life often are totally fortuitous. My mother was a nurse, and I grew up reading some of her nursing books, and that is what I’m sure made me want to be a doctor. When I was in junior high school, someone gave me a book of psychology, and though it was well above my head, I thought, wow, the brain is extraordinary, I really want to know more about this. So it was already in my head even before I went to college that the neurosciences were the most interesting field of knowledge that I could possibly get involved in. I was almost predestined to go into neurology.

You have written primarily for other medical professionals. What were some of the challenges you faced when you were setting down your thoughts for a general audience?

I’m relatively adept at translating science into lay language, but when it finally came down to it there were lots of areas where the editors said, “No, you‘ve got to write it differently.” There’s no question,  it is not an easy transition from professional language into the layperson’s language. But I’ve edited journals for a long time, converting scientific mumbo-jumbo into something that was understandable by people who weren’t in that specific field, So I had some experience. The most difficult, really, was to get it polished and readable by the generalist—the intelligent person who isn’t specialized in this field.

Many of the people who pick up this book are going to be interested in one or two diseases. Why is it important for them or their loved ones to read about other brain conditions?

Dana has a book already—a large, sort of medical bible—called the Dana Guide to Brain Health, written for the lay person and edited by four very eminent neuroscientists. It provides a tremendous encyclopedia from one end to the other of how the brain is put together, how it works, how the nerves stimulate one another, what the chemicals and the diseases in the brain are. But it’s the sort of thing you use an encyclopedia for: You pick it up and look in the index for epilepsy, but you don’t read it from one end to the other.

What I wanted to do was to provide a readable book that general readers would be able to use to see the whole panoply of neurology, and then maybe if they wanted to look more specifically at some of the areas, they could go on to the brain-health book.

Are the patients you see generally well-versed about neurology and the neurosciences?

All of us, even in our own field, are fine until we get a condition. Then you simply throw up your hands and say, “I know nothing about it and I’m going to read about it.” I’ll never forget a colleague of mine who had done all her obstetrics and gynecology and knew everything that was happening, who got pregnant and suddenly went into a blue fit. I think the same thing happens in regards to patients. Some of them are very knowledgeable; some of them are not.

The interesting thing is that many patients come to me as a specialist in Lou Gehrig’s disease having looked up things on the Internet and made their own diagnosis, which is somewhat weird. They say “my doctor won’t tell me what I’ve got but I’ve looked this up and think I must have Lou Gehrig’s disease.” So patients are very different depending on their experience with a medical professional, the actual condition itself and so forth. It’s a very different picture than it was thirty years ago. Then you’d say, “Mrs. Brown, you have a brain tumor,” and she’d say, “What’s a brain tumor?” Now people will come to specialists with printouts from the Internet, an enormous mass of information, but without the knowledge to interpret much of it. Some of the information is accurate, some of it very inaccurate, some of it based on marketing, some of it contradictory. The real difficulty is to for the poor patient to try to find his way through that mishmash.

The only way that they can really do that is with a caring doctor who is willing to give the time to go through each of these things and say, “No, that’s not reliable, that’s not what you have; no that’s out of date now, we now use this drug,” and so forth. It’s both helped the doctor-patient relationship and made it more difficult, because to some extent the patient is not coming in just with their own complaints, but also for an interpretation of this inch-and-a-half-thick printout.

You include many case studies in your book. Were there any that you weren’t able to include? Were there any that especially stood out?

One case story–a wonderful patient of mine who had ALS—is not actually in the book. He was a bank trust officer but he wrote humorous financial columns, and he was really a great writer. He wrote for the Key West Citizen, and he was a very gifted and amusing character. His name was Gibb Peters. And Gibb decided that he wasn’t going to give in to the damn disease, he was going to fight it, and his way of fighting was to set out on an odyssey through the intracoastal waterway from Key West, Florida, up to New York and back again, while he was really dying from the disease. He couldn’t speak, he was driving his boat with his feet, he was feeding himself with a gastroscopy tube into his stomach because he couldn’t swallow, and yet all the time he wrote these both very poignant and very amusing stories, adventures that he had, insights that he had. That’s a story that will be a book of its own.

Obviously, when you are choosing patient stories, you have to choose ones that illustrate your points, but you don’t want to choose ones that are terrible. I tried to give a balance. You’ll see in the stroke chapter there’s one story about someone who had a transient ischemic attack, which is something that clears up completely, and somebody who had a bad stroke. It’s important to give both of those. They’re the hook on which you can hang the discussion about why one is bad and one isn’t bad, and how the brain functions when certain areas are damaged.

Based on what you written and your experience, what is some key advice for people either living with these diseases or taking care of such people?

You have to choose your doctor right. The crucial thing is to find a doctor that you like, a doctor you respect, a doctor who will talk to you. One that is not so rushed and has the empathy that you need and deserve. And that’s difficult. Neurology is an interesting area. You really want a neurologist who’s got a good deal of humanity and empathy to help you through some of these conditions that are incurable, unfortunately.

As I teach my medical students, incurable just means you have to spend more time with the patient. Once there is a cure, you don’t need to spend a great deal of time with the patient. If this an incurable disease, as a doctor you really need to spend a lot of time holding the hand of the dying and comforting the family, and those of us who do that are a different breed, from, let’s say, the surgeon who wants to cut out the tumor or replace the hip joint. It really is a different approach to medicine.

What do you hope people take away from your book?

I would hope that this book had something of the interest that Oliver Sacks produced in his compilation of stories the The Man Who Mistook His Wife for a Hat. Oliver is a wonderful neurologist who picked up on patients with the most weird conditions of the brain and was able to write about them in a fashion that turned readers on. I would like people to enjoy the book to the same extent as they enjoyed his books, but perhaps also get a broader understanding of the most complex organ of the human body, the brain.