As a young medical student, Scott Strine, DO, considered oncology, until a job as a tumor registrar that made an early part-time job as a bank teller seem like an adrenaline rush. Fortunately for Duke, Strine loved his neurology rotation at Ohio State. In this week’s “Spotlight” interview, Strine talks about his work in the general neurology clinic, Durham VAMC, MOPC, clinic and other locations. He also discusses how his time in private practice in Florida compares to this work, and whether he’d root for Darth Vader, Hannibal Lecter, and the Joker or the UNC basketball team.
What are your current responsibilities within the Neurology Department? What does a typical day for you look like?
Fortunately, I don't have a typical day. Each day of the workweek is quite different for me. On Mondays and Fridays, I see patients in my own general neurology clinic at Duke. On Tuesdays, I work in my own clinic at Duke in the morning, but then work with our residents in the afternoon in the neurology clinic at the Durham VA Medical Center. On Wednesday mornings, I’m again in the VA neurology clinic, but then head upstairs in the afternoon to perform EMG/NCS studies. On Thursdays, I cover inpatient neurology consultations at the VA hospital, and perform more EMG/NCS studies there in the afternoon. I also serve as one of the attending physicians for the Duke Neurology MOPC Clinic on Friday afternoons, along with Drs. Morgenlander and Eckstein. In addition, I coordinate the Neurology Grand Rounds Lecture Series, and occasionally cover a weekend for the VA or Duke inpatient neurology services.
How and when did you first get interested in neurology?
When I first arrived at medical school, I thought that I would likely become an oncologist. As a senior in college, my research project involved oncogenes. During college, I first worked part-time as a bank teller, and then worked for a couple years as a tumor registrar. I won't bore you with the details of being a tumor registrar. I will just tell you that a job as a tumor registrar makes a job as a bank teller seem exhilarating, like something only an adrenaline junkie would apply for. Anyhow, once I started rotating through clinical specialties during my 3rd and 4th years of medical school, I realized that I didn't actually enjoy the day-to-day activities of an oncologist. Fortunately, I spent 2 months rotating through the Department of Neurology at Ohio State University, and loved it immediately. One of my attending physicians from that time (a really great guy) is now working in Wilmington, NC, and it always gives me such a thrill to see one of his patients for a 2nd opinion here at Duke.
You spent several years in private practice in Florida before coming to Duke. What’s the biggest difference between working there and working for an academic medical center?
I really enjoyed my 8 years in private practice, and I loved living in the endless summer of Southwest Florida. The biggest difference is that as a private practice physician, I spent a great deal of time learning, discussing, and managing the BUSINESS of medicine. Coding, billing, collecting, hiring, firing, pension plans, health care benefits, building offices, buying equipment, etc., etc. It was rewarding and fun and exciting to run my own private practice, but there was also a lot to learn! Since starting at Duke, the fun has come from focusing on the MEDICINE of medicine. I love being surrounded by brilliant neurologists (young & old) every day. I learn a lot every year from our Grand Rounds lectures, and from trips to the big national neurology meetings, but I learn even more from my neurology colleagues here at Duke. Therefore, to their chagrin, I never hesitate to ask questions of our brilliant subspecialists in stroke, epilepsy, sleep, MS, headache, neuromuscular, etc.
2019 marks your 16th year at Duke. How does your work now compare to how it did in 2003? What is the biggest change in your work that you see coming over the next decade?
I think the biggest change since 2003 has been the increasing computerization of medicine. In particular, our increasingly large and complex electronic medical record has changed the way I do my work every day in both the inpatient and outpatient settings. When I first started in private practice, I wrote everything by hand, including inpatient & outpatient notes, orders, referrals and prescriptions.
Now, everything is done using a computer and a printer. Some of this computerization has been very good. For example, it is now easier to review past medical records and imaging studies. It is also now much easier and faster to obtain good medical information, including practice guidelines, medication prescribing information, etc. However, the uncontrolled growth of the electronic medical record, including its electronic secure messages, refill requests, and other notifications, has gradually become a larger and larger, nonstop, 24/7/365 responsibility for both providers and support staff. Therefore, during the next decade, I hope there will be an effort to limit, control and manage this electronic beast, so that we can all maintain a reasonable level of work-life balance.
Your Duke basketball updates are an established part of Neurology Grand Rounds. If UNC was playing basketball against Darth Vader, Michael Myers, Hannibal Lecter, and the Joker, who would you root for?
Well, I would obviously tell anyone within earshot that I was going to be rooting for UNC that night. I would likely even back up that claim with statements such as, “UNC is a great school. You know, my son graduated from there!” But then, as the game began, I would gradually begin to realize that somewhere deep down in the darkest corner of my soul, I was actually feeling a little bit happy when Vader banked in a beautiful midrange jump shot, and was instead feeling a little bit angry when Luke May sunk an uncontested 3-pointer from the corner.
Eventually, I would start to rationalize, mumbling things like, “I'm not saying Vader is a great guy, I'm just saying it's impressive that he hit that shot wearing that giant black mask.” If the game stayed close and hotly contested, I would eventually get louder and more obnoxious (“Foul on Lecter?! Are you kidding me?! He didn’t even bite his face!”) And then, unfortunately, I would be asked to leave.
Other than basketball, what passions or hobbies do you have outside of work?
During the past 3-4 years, I have become a pretty avid runner. I've now run the Brooklyn Half Marathon (a huge, wonderful, festival of a race) 3 years in a row. I've also developed an interest in little convertibles (I've now owned 5 in a row), travel (I am planning to visit Portugal and the island of Mallorca this summer), movies (my wife and I attended Sundance Film Festival in January), snow skiing (especially in Park City, Utah), and almost any sport played with the ball, including Ohio State football, Duke lacrosse, and Manchester United soccer.