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  1. Michael Chen
  1. Correspondence to Dr Michael Chen, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA; Michael_Chen{at}

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Despite our confusing yet enduring polysyllabic labels as interventional neurologists, interventional neuroradiologists or endovascular neurosurgeons, there is a common feature we all share. Our success is largely defined by our procedural proficiency, which can dramatically restore function or cause frightening neurologic injury. We routinely get thanked for ‘saving someone's life’.

This inherent focus on procedures that have profound implications may have an unintended effect on how we practice medicine. In the office we introduce ourselves, obtain a focused medical history, perform a medical and neurologic examination, review the imaging findings, and then decide on a treatment option. As a practice gets busier and even more data need to be reviewed, to save time, this consultation is further distilled down to the essentials. Then, we start talking at our patients. We start talking in more absolute terms. We remember our patients more by their angiograms than their faces or personalities. Decisions are quickly reached and we find ourselves persuading patients to follow our plans. With time, a sense of infallibility grows.

Whether in private practice or academic medicine, physicians are directly incentivized to serve themselves first. Compensation often increases for greater quantity, rather than quality, of procedures performed. To grow practices, physicians are increasingly promoting themselves on webpages, social media, and online videos. Promotion in academic medicine is based on documenting a long list of personal publications, accomplishments, and accolades. The process of maintaining an academic CV …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.