There are just certain times when a neuro exam just isn't going to go smoothly and won't be of much value...I was lucky enough to have TWO of those situations today pawned off on me by my attending. Consequently, as of this morning I had done 1 independant neuro exam...so as you can imagine, it went smoothly.
1) A lovely, demented, non-english speaking Pakistani woman presents to the clinic with her son who claims initially that she can not speak, form new memories or remember much from the distant past. Ok...I'm a fairly bright and patient guy, but patience and creativity have their limits. Son acting as translator, I manage to get about 40% of the neuro exam done and have a slight clue that she does have some functional capability. I go back and give my very disorganized, half completed report to the attending who then feels the need reward my performance by mercilessly pimping me on all of the causes of dementia. Anyway, he gets frustrated while repeating the exam and gets frustrated after extracting about half as much as I did out of the lady and gives up...I felt a little bit satisfied, but only a little.
2) There are two consults on the psych ward that the attending wants to avoid: I'm assigned the chronic schitzophrenic found wandering the streets and my classmate gets the lovely, cognitively intact gentleman that's getting discharged in about 10 minutes with a clean bill of health. I'm sort of getting the feeling that I'm not the favorite student on this rotation. My patient's HPI is completely disjointed, his MSE is literally the most painful exercise in futilty that I have every striven to complete...fortunately the rest of the exam was less than painful.
Again...I don't see myself doing this EVER.
1) A lovely, demented, non-english speaking Pakistani woman presents to the clinic with her son who claims initially that she can not speak, form new memories or remember much from the distant past. Ok...I'm a fairly bright and patient guy, but patience and creativity have their limits. Son acting as translator, I manage to get about 40% of the neuro exam done and have a slight clue that she does have some functional capability. I go back and give my very disorganized, half completed report to the attending who then feels the need reward my performance by mercilessly pimping me on all of the causes of dementia. Anyway, he gets frustrated while repeating the exam and gets frustrated after extracting about half as much as I did out of the lady and gives up...I felt a little bit satisfied, but only a little.
2) There are two consults on the psych ward that the attending wants to avoid: I'm assigned the chronic schitzophrenic found wandering the streets and my classmate gets the lovely, cognitively intact gentleman that's getting discharged in about 10 minutes with a clean bill of health. I'm sort of getting the feeling that I'm not the favorite student on this rotation. My patient's HPI is completely disjointed, his MSE is literally the most painful exercise in futilty that I have every striven to complete...fortunately the rest of the exam was less than painful.
Again...I don't see myself doing this EVER.
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