Can AI interpret MRI scans better than human doctors?

AI is highly capable of interpreting MRI scans and diagnosing conditions based on symptoms. However, in neurosurgery, AI currently struggles with the complex physical decision-making required in the operating room, especially when surgeon skill level is a critical factor.

How can I find the best neurosurgeon if I can't access top specialists?

It's best to ask friends or colleagues within the healthcare profession to recommend someone. Neurosurgeons often know who the top specialists are for particular procedures based on their publications, lectures, and case volumes, which is hard for a layperson to ascertain through Google alone.

What are the risks of being operated on by a neurosurgeon early in their career?

While residents must train, patients may prefer experienced surgeons. It can be difficult to ascertain a surgeon's exact experience level, but examining their CV for graduation dates can provide an estimate, suggesting one might prefer someone with 5-10 years of experience post-residency.

Why do so many neurosurgeons get divorced?

The demanding nature of neurosurgery, with long hours, unpredictable calls, and the constant mental weight of patient care, often leads to surgeons being physically and mentally unavailable even when home, straining relationships.

Is the brain a bottleneck to living forever?

Yes, the biological nature of the brain, with cells that don't reproduce or regenerate, makes it a key challenge for indefinite human lifespan. The hope lies in potential future inorganic replacements for brain function, possibly aided by AI.

Can deep brain stimulation alter personality or desires?

Yes, deep brain stimulation can profoundly affect personality, desires, and feelings by altering brain circuitry. It has been used to treat conditions like Parkinson's, epilepsy, and potentially depression, and can even influence preferences like musical taste.

What is the biggest obstacle in modern brain surgery?

The primary bottleneck is the physical barrier of the skull. Current methods often require invasive procedures like opening the head with scalpels and drills. The 'holy grail' is to deliver energy or manipulate the brain non-invasively, similar to how endovascular procedures are performed through blood vessels.

Will brain-computer interfaces like Neuralink be regulated?

Initially, yes, BCIs will be regulated by bodies like the FDA due to safety and efficacy concerns. However, once the technology is proven completely safe and commonplace, like cell phones, regulation may shift towards governing its use if detrimental to society, rather than its mere possession.

Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces

Conversations with Tyler

News & Politics7 min read59 min video

Jun 11, 2025|658 views|20|3

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TL;DR

Neurosurgery training is long but necessary for wisdom. AI has limits versus surgeons' skills.

Key Insights

Neurosurgical training is a lengthy process (6-8 years post-med school) that emphasizes experience and wisdom, balancing education with maturity for complex surgical decisions.

While AI excels at diagnostics and imaging interpretation, it cannot yet replicate a surgeon's real-time decision-making in the OR, especially considering individual surgeon skill.

Hospital metrics often prioritize easily measurable outcomes like infections over crucial surgical goals such as complete tumor removal, misaligning incentives.

The economics of medicine often fail to account for surgeon experience in reimbursement, paying the same rate for a novice and an experienced surgeon.

Finding a top neurosurgeon relies on informal networks and professional recommendations, as objective consumer-facing data is scarce.

The demanding nature of neurosurgery impacts surgeons' personal lives, contributing to high divorce rates and requiring a constant balancing act between professional dedication and personal well-being.

Advancements in brain-computer interfaces and deep brain stimulation offer significant potential for treating neurological and psychiatric disorders, and enhancing human capabilities.

The brain remains a bottleneck for longevity due to its biological limitations, though AI-driven information processing offers a theoretical alternative.

The concept of a unified self is challenged by neurological phenomena like split-brain patients and hemispherectomies, suggesting a more modular and narrative-driven consciousness.

Minimally invasive techniques and non-invasive access to the brain (like focused ultrasound) are seen as the future, overcoming the 'skull barrier' in neurosurgery.

Deep brain stimulation can profoundly alter personality, desires, and behaviors by modifying specific brain circuitry, highlighting the plasticity and mechanical nature of the mind.

Epilepsy, a disease of brain circuitry rather than anatomy, offers insights into how altered brain function can impact experiences like religious beliefs and consciousness.

THE RIGOROUS PATH TO NEUROSURGERY

Becoming a neurosurgeon involves a substantial commitment, typically comprising four years of undergraduate study, four years of medical school, and an additional six to eight years of specialized neurosurgical residency. This extensive training period, averaging a total of 16 years, including a one-year internship and subsequent residency years, is designed to cultivate not just technical skill but also the crucial wisdom and maturity required for high-stakes decision-making. While Dr. Theodore Schwartz acknowledges that some aspects of undergraduate and early medical training could potentially be condensed, he emphasizes that the years spent honing surgical expertise are invaluable, ensuring surgeons possess the experience needed to handle the most delicate and critical aspect of human health: the brain.

THE ROLE OF AI IN NEUROSURGERY AND BEYOND

Artificial intelligence shows promise in areas like diagnostic interpretation and analyzing MRI scans, tasks where it can even outperform human doctors. However, neurosurgery presents unique challenges distinct from general medicine. Unlike diagnostic dilemmas, neurosurgical decisions often revolve around complex physical choices made intraoperatively. AI struggles to account for the subjective skill levels of individual surgeons or the nuanced 'Sophie's choices' surgeons face, such as balancing tumor removal with preserving patient function. While AI can process vast data, it lacks the contextual understanding of a surgeon's unique abilities and the specific patient factors that govern treatment selection, highlighting AI's current limitations in replicating the full spectrum of surgical expertise.

MEASUREMENT, MOTIVATION, AND MEDICAL ECONOMICS

A significant disconnect exists between what hospitals prioritize and what is most critical for superior patient outcomes in neurosurgery. Hospitals often focus on measurable metrics like infection rates and readmissions, driven by government reimbursement policies, rather than on the completeness of tumor removal or neurological preservation. This misalignment means that crucial aspects of surgical success, particularly those involving complex trade-offs, go untracked. Furthermore, the economic structure of healthcare often fails to differentiate between surgeons based on experience; reimbursement rates are frequently the same for a newly trained surgeon and one with decades of practice, irrespective of the dramatic difference in skill and product quality they might deliver.

NAVIGATING THE CHOICE OF A NEUROSURGEON

For patients seeking a neurosurgeon, especially when faced with limited options or budget constraints, the process can be opaque. While most top-tier surgeons accept insurance, finding the 'best' often relies on informal networks and recommendations from healthcare professionals rather than easily accessible public data. Consumers may be awed by the title of 'neurosurgeon,' leading them to accept advice at face value. Dr. Schwartz advocates for seeking multiple opinions and leveraging connections within the medical community, as surgeons themselves are best positioned to identify leading practitioners based on reputation, publication, and volume of complex cases performed. He also implicitly suggests examining a surgeon's graduation date from training as a proxy for experience.

THE INTANGIBLES: STAMINA, CONCENTRATION, AND EMOTIONAL TOUGHNESS

Neurosurgery is not solely an intellectual pursuit; it demands significant physical and mental fortitude. Surgeons must endure long hours of standing, maintain focus for extended periods, and operate with minimal sleep, all while managing immense pressure. Dr. Schwartz shares his personal struggles with back pain due to prolonged standing and highlights the importance of core strength and practice. He emphasizes that raw IQ is less critical than qualities like grit, stamina, judgment, coordination, and the ability to remain mentally sharp and emotionally resilient, even in the face of life-altering outcomes. Music, particularly playing bass guitar, is mentioned as a helpful practice for developing concentration and dedication.

THE CHALLENGES OF CONSCIOUSNESS, SELF, AND BRAIN FUNCTION

Exploring the philosophical implications of brain function, Dr. Schwartz discusses consciousness, the self, and free will. He posits that our sense of a unified self might be an illusion, a narrative constructed by the brain after actions have already been initiated by various processing modules. Phenomena like split-brain surgeries, where the brain's hemispheres are separated, and hemispherectomies, where half the brain is removed, do not result in individuals feeling like two or half a person respectively, suggesting flexibility in how the brain defines identity. This perspective challenges traditional notions of agency, implying that our actions may be determined by brain processes, with our conscious self serving as a storyteller that rationalizes these events.

DEEP BRAIN STIMULATION AND BRAIN-COMPUTER INTERFACES

Deep brain stimulation (DBS) is a powerful therapeutic tool, already effective for treating Parkinson's disease and epilepsy by modulating aberrant neural circuits. Its potential extends to conditions like depression, OCD, and Tourette's syndrome, with the capacity to alter behavior, desires, and feelings. Similarly, brain-computer interfaces (BCIs), exemplified by Neuralink's flexible electrode technology, are revolutionizing possibilities for paralyzed individuals, enabling movement of robotic limbs and communication. The discussion extends to enhancing normal human capabilities, potentially allowing direct thought-based communication via wireless interfaces, bridging the gap between biology and technology.

THE FUTURE OF BRAIN INTERVENTION AND LONGEVITY

The primary bottleneck in advancing neurosurgery is the invasive nature of accessing the brain through the skull. Future progress hinges on developing non-invasive or minimally invasive techniques, such as focused ultrasound to open the blood-brain barrier, optical methods, and potentially nanobots. While the biological brain presents a limiting factor for extreme longevity due to its non-regenerative cells, the possibility of replicating its complex information processing through inorganic means, perhaps via advanced AI-driven interfaces, offers speculative hope for extended existence. The regulation of these powerful brain-interface technologies is also a critical consideration, balancing individual freedom with societal implications.

EPILEPSY, BELIEF, AND THE NATURE OF HUMAN EXPERIENCE

Studying epilepsy has illuminated the complex relationship between brain circuitry and human experience. Dr. Schwartz notes that epilepsy often involves abnormal circuitry in an otherwise anatomically normal brain, leading to diverse symptoms that can mimic profound human experiences. He recounts cases where seizures triggered intense religious experiences, which then ceased upon successful epilepsy treatment. This suggests that fundamental beliefs and subjective states can be directly influenced by altered brain function, prompting reflection on the biological underpinnings of religion and consciousness, without diminishing the personal significance of these experiences for individuals.

BALANCING CONFIDENCE AND HUMILITY IN SURGERY

The high-stakes environment of neurosurgery necessitates a delicate balance between confidence and humility. Surgeons must possess the assuredness to take on life-altering procedures with patients entrusting them with their most vital organ. Simultaneously, they must exhibit profound humility to acknowledge personal fallibility, learn from mistakes, and recognize the inherent risks involved. Arrogance, unchecked confidence, can lead to deception and a failure to adapt or improve. Dr. Schwartz suggests that identifying extreme arrogance is complex, as some outwardly humble individuals may mask it, while true mastery lies in combining self-assurance with a constant drive for self-improvement and ethical patient communication.

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Navigating Neurosurgery: Dos and Don'ts

Practical takeaways from this episode

Do This

Seek second or third opinions from trusted medical professionals.

Research your surgeon's background and experience using their CV or publications.

Develop and strengthen core muscles for the physical demands of surgery.

Combine confidence with humility: believe in your abilities but acknowledge limitations and learn from mistakes.

Prioritize focus, stamina, and a positive attitude during training and practice.

Consider the surgeon's experience, not just years of training, when making a decision.

Avoid This

Rely solely on online searches for 'best' neurosurgeons; results can be unreliable.

Assume all surgeons are reimbursed equally; insurance rates do not reflect experience.

Underestimate the physical and psychological demands of neurosurgery.

Expect AI to fully replace human decision-making in complex surgical scenarios.

Be swayed solely by a surgeon's title; investigate their specific experience and outcomes.

Forget that a surgeon's personal life and state of mind can impact their performance, even if not overtly visible.

Common Questions

The path to becoming a neurosurgeon is long, typically involving four years of undergraduate education, four years of medical school, and then six to eight years of specialized neurosurgical residency training. This means training can extend to age 33 or later.