Neurosurgery is a discipline that appeared due to an escalating need for exclusiveknowledge in the surgical and non-surgical treatment of certain diseases affecting the nervous system, especially the brain and spinal cord. A neurosurgeon has technical expertise in the effective surgical treatment of neurological diseases. Movement disorders such as Parkinson’s Disease, dystonia, and tremor are common examples of how the nervous system can be affected.

Dr. Konstantin Slavin, a neurosurgeon with the UIC National Parkinson’s Foundation Center of Excellence, states that most of his practice revolves around such disorders. An interview with Dr. Slavin gave me a better understanding of what neurosurgery entails and what his specialty is all about.

What is your educational background?

I went to medical school in Azerbaijan right after high school since there is no undergraduate system there. After that I completed a neurosurgery residency in Moscow, came to the US to do research, and completed another residency in functional neurosurgery that lasted six years. I then did a one-year fellowship in functional and stereotactic neurosurgery.

What made you decide to go into neurosurgery and not any other specialty?

It’s probably the most fascinating part of surgery. I wanted to be a doctor since I was very young, and once I got into medical school I was not sure which specialty I wanted. Early on in school I realized I wanted to be a surgeon, but I wasn’t sure which one. By chance a neurosurgical hospital opened up close to my home, and I started to work there as a nurse. I was exposed to neurosurgical patients and the type of disorders they were treating. I realized that there was nothing more important than the human brain, and if we can fix something other people cannot, that is probably the best reward anyone can have. So I decided to be a neurosurgeon in my fourth year of medical school. It was a very serendipitous set of events, but I’m very happy that it actually happened.

What is a sub-specialty and why did you get into yours?

We don’t refer to it as a “sub-specialty,” because it’s more in-depth and deals with our bigger specialty, which is neurosurgery. So there are several of what we call “super-specialties.” My super- specialty is stereotactic and functional neurosurgery. The “stereotactic” refers to the approach we take to get to the brain, and the “functional” refers to the disorders such as chronic pain and movement disorders like Parkinson’s, and tremor. The reason I chose my specialty was because it is the most fascinating part of neurosurgery. Even though it doesn’t treat life-threatening diseases, such as aneurysms or brain tumors, it does affect the quality of life of patient by improving symptoms of pain and movement disorders. It improves functionality, the way patients enjoy their life. Though we may not extend it, we certainly make it more enjoyable.

What are the most common types of problems you see in your field?

The most common problems that come to us can’t be solved by medication or medical management. They must be severe enough to undergo surgery when the patient comes to us, such as when Parkinson’s is no longer treatable with medication alone. We treat different types of pain in the face, arms, legs, right regional pain syndromes, and trigeminal neuralgia. Movement disorders include epilepsy, Parkinson’s, dystonia and all kinds of tremor.

What are your current research projects at UIC?

My research is essentially limited to clinical projects. I don’t have any basic research lab like some of my colleagues. I’m involved in evaluation of certain surgical procedures, diagnostic modalities used during surgery. Right now I am in a project that relates to the evaluation of the high power MRI at this university for making surgery for Parkinson’s Disease more accurate. There are other projects that are related to the outcome of spinal cord stimulation for pain and certain medication that is administered into patient’s spinal fluid. Also, I evaluate different ways to manage congenital malformations of brain by testing two different materials to see which one works better. Recently I have completed research that checks patient satisfaction with different generators implanted in the chest wall.

What kind of medical breakthroughs would you like to see in the future?

I’m ready for any breakthroughs. I would like to see any breakthrough that would extend the patient’s life, the way people live on a daily basis, anything that eliminates pain to make patients more mobile, anything that will allow them to turn back into society and become normal in the way that they interact with their family, themselves and work. In my particular field I would like to see something that will heal patients’ pain or Parkinson’s Disease -- in effect something that will eliminate surgeries that I’m doing right now, because I’m not really curing anybody, I am just trying to suppress their symptoms. By now both patients and doctors are ready to find something to cure certain medical conditions.

With malpractice premiums being at all time high, what is in the future for neurosurgery?

Malpractice is a big issue, in medicine in general, and in Illinois in particular. Unfortunately, Illinois does not have a tort reform legislation. As a result rising malpractice premiums are a rapidly worsening phenomena. The fact that there is no limit on non-economical damages makes malpractice verdicts completely disproportional to the extent of the injury and the doctors’ ability to actually face the amount of punitive damages. Consequently, a large number of neurosurgeons cannot afford to maintain malpractice insurance. They are forced to leave the state of Illinois and move to states with better legislation -- for example, Indiana or Wisconsin. Some neurosurgeons are forced to retire early, so you see fewer doctors, and patient care becomes less accessible. Inevitably it will result in a higher mortality or a worse outcome. Right now the malpractice situation in Illinois is in a real crisis because neurosurgery is traditionally associated with the highest malpractice premiums out of other specialties.

What is it like to balance your practice, research and family life?

Well, I’m trying to maintain the home life as well as possible, but it is difficult with the workload, because it takes a majority of my time. But whenever I’m free I try to spend it at home with my family. My children are growing fast and some part of their childhood, unfortunately, I missed, because I was a resident. Back then there was no free time at all. Now things are getting a little better and I’m enjoying their company more and more. The research is an important part of my daily routine. Since I operate a lot and see a lot of patients my research projects are moving relatively fast. I try to integrate research into my daily practice as much as I can.

In your opinion and experience what makes a good physician?

That’s a difficult question. The most important thing is that you have to care. If you care about your patient, then everything else comes more appropriately. If you like your patient and are concerned about their well-being, then the outcomes will be better. The general reasoning that I think every physician should have is that the patient’s interest should be the highest priority in whatever they do. Independent of how the social situation goes, or what the malpractice plan does for us, the patient’s well-being is still the number one priority for me. It should be for any good doctor. Everything else is secondary. That doesn’t mean the doctor shouldn’t sleep at all or not have a life outside the hospital. All it means is that whatever situation you end up being in, you have to worry about the patient first, and everything else comes later.

Any advice for young students aspiring to enter the field of medicine?

The most important thing is to get exposed to the field. The only thing worse than being a bad doctor is to constantly feel sorry for making the wrong choice, and the way to avoid that is to a have a clear understanding of what you are getting into. If, despite all the problems doctors encounter on a daily basis you still want stick with it, then keep pursuing it. The advice I can give to young students is to make an informed decision, don’t choose it just because someone in your family is a doctor or you saw someone on television. Try to determine if that is your true calling, and if it is then be persistent and do it.

If you could do something differently, would you?

I ask myself that once in a while, and fortunately, I cannot imagine doing something different from what I’m doing right now. I would probably make the same mistakes again if I had to.