A Comically Absurd Exam

Does it feel like spring at your house? We had a brief moment of chilly over last weekend -- and then it started getting warm again. Since there's no real spring here, we're definitely in the early stages of summer.

Well, today's blog is going to be more of a community service announcement -- and a testament to how (much better) we do things here. Today, I went to the neurologist. Given my history, and the fact that I've put this off FAR too long -- it seemed like a good idea. I'll leave all of the names out of the picture, but I will say that the person that I saw was an MD -- and the student that I saw was a DO student. So, I arrived at the neurologist's office, stack of MRIs and CTs in my hand -- to see if they'd do a follow-up MRI on my head and neck.

In case I haven't filled you all in on this (or you don't want to go through the archives) -- I was diagnosed with a Chiari Malformation in 2005 and had surgery to "correct" it shortly thereafter. The student walked me into the room, introduced herself, and was supposed to take my history. She asked me a couple of questions -- brief thoughts on why I was here with very little about my history. I watched as she wrote down about 5 lines with 2-3 words on each line. In her defense, I have no idea what the words said, but after hearing her give her summary to the doc, she missed a lot of what I said.

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So, the doctor came in, asked me a few more questions -- a few more about how my condition presented itself, why I was there, and what I hoped to gain from the visit. She made a number of assumptions about me based on her perception without questions. All of them were wrong. When I questioned her back, she had no idea how to handle me or what to say. My favorite question that she asked me was, "When was the last time you felt normal?" To which I replied, "I've never felt normal -- what a strange question to ask me."

It's easy, as a physician, to make assumptions about people because of the way they look, how they're dressed, their age, their background, or a million other characteristics. Know that many times you will be wrong when this happens. This was a great reminder for me to not fall prey to this. I will admit that between the poor history taking and the lack of bedside manner, it didn't set the tone or instill much faith.

Then she did her "exam." Now, if you've ever had a neurological exam, you know that it takes a while. There's sensory testing for light touch and pain, strength testing, cranial nerves (if you're going to be thorough), reflexes, and cerebellar testing (and a few random other things thrown in). Going through this exam, even quickly, takes 10-15 minutes. This doesn't include any advanced testing -- it's just a screen. The exam performed on me involved the patellar reflexes only (normally biceps, triceps, brachioradialis, patellar, Achilles, and pathological reflexes as the basics), 3 of the strength tests (I do 16), NO sensory testing, and 1 cerebellar test (and not the best one at that). I kept waiting for her to do the rest of the exam. It never happened. No cranial nerves were tested. Now, given how severe my condition was originally (my brainstem was herniated to the second vertebrae) and all of the fallout from that, wouldn't you have done at least the basic exam?

After waiting for 30+ minutes, talking to the student for maybe 3 minutes, dealing with the doc for a max of 10, and sitting through that pathetic exam, I can't possibly imagine how she could have learned anything about my current condition. Before I even walked in the room she had a prescription for an MRI written out. Maybe she'd already decided that the exam was extraneous. I have no idea. But I'm STILL baffled. After offering me a prescription for Valium (for the MRI -- assuming I'd be claustrophobic -- which I'm not), she excused herself and walked out.

I shouldn't complain. I wanted the MRI -- in fact that was the main reason that I scheduled the appointment. But I also expected that I would be seen by a "real" doctor who would offer some level of expertise -- beyond what I already have. I wasn't.

Through all of my educational forays, and now at the end of my time here at National, I can tell you that there's no excuse for a pathetic exam. We're taught better than that. We're taught to be thorough -- to evaluate the tracts, the function. We're taught to listen, watch, and test. We're taught to ask questions -- LOTS of them. We're taught, and have the opportunity, to be good.

I don't know that I'll go back. I have my MRI scheduled. I plan on taking the films with me when I leave and evaluating them myself. I never anticipated having the skills to do that. Between my own personal studies and my exposure here, I definitely trust my own evaluation more than I trust hers.

Here's hoping that all the docs you meet are good ones, and that if you're studying -- that you'll become one of the good ones too.

Have a great week, everybody! Work hard.