Tuesday, September 15, 2009

What Does a Neurology Exam Involve?

Several of you have written in to ask what a neurology exam involves, and how it differs from what your regular doctor may do.

Neurologists learn to do very detailed exams, studying reflexes, strength, coordination, and many other systems. These involve great skill in noticing important, sometimes subtle, details.

To give you an example, today I was reviewing some notes from a neurologist across town. Here is a detailed complete neuro exam from her note:

Obviously, it takes years of training, and a great deal of time, to notice things like this.

To give you a more thorough picture, here is another very detailed exam by the same doctor on the same patient, done 1 month after the initial visit. Notice how she carefully documents changes in his condition:

So that's what a neurology exam involves.


Anonymous said...

Hense the post from, "Ask an MD" about why neurologists are so strange"
What an odd thing to put in a med record

Anonymous said...

Are 'Cayman Islands' and 'Bates Hotel' special Latin codes for anything in particular?

As the sentences stand, the examiner could've been giving a police report, intake at mental health facility, or even allergenicity report of different proprietary T-shirts. (or trying out a new pen--e.g. something more up-to-date than 'Quick brown fox jumps...')

Ed Adams said...

Having worked for many physicians in various specialties, I must say, this level of comprehensive documentation is not exclusive to the field of Neurology. One could write a very humorous book from dictations alone.

SumDood said...

What, no pants?

modesty press said...

I am sorry, Dr. Grumpy. This will just no do. It is most unscientific.

For one thing you have not provided an example of writing by this neurologist from before she went to neurology school. Perhaps she once wrote perfectly informative, sensible comments at one time in her life.

Also, you have not provided an example of a "double-blind, placebo controlled" experiment involving thousands of randomly selected neurologists.

After this post, I am not sure I will ever be able to take anything you write seriously ever again.

Grumpy, M.D. said...

Sorry, Modesty Press, but my attempts to secure funding for the above research were unsuccessful. Only limited funds were found in my sofa cushions, and they were spent on Diet Coke and Pop-tarts.

Thomas said...

I get the image of the neurologist walking in the room, eyeing the shirt, and then asking the patient to raise his arms to fully see the shirt.
"Hmm...Mr Smith, can you raise your shirt? I'd like to visualize the field better...that's fine. Is there anything written on the back? No? About the wording- is it screen printed? Why is your eye twitching? Can we keep this professional, please...Can I see the tag on the shirt? Where was it made? China? Mmm hmm...Cotton?"

The Lonely Midwife said...

Thank you! I always thought something was missing from my H&P's. Damn, EMR, there wasn't a box for that.

Grumpy, M.D. said...

Lonely- you mean an essential part of a midwife note DOESN'T INCLUDE DOCUMENTATION OF THE PATIENT'S T-SHIRT DESIGN?!!

THAT SHOULD BE MANDATORY! It's critical information like that that helps in making birthing decisions!

John Woolman said...

Working rule of thumb that I teach students in the UK about medical records is never to write anything in the clinical record that you would be embarrassed to have read out in open court. "So doctor, would explain to the court the medical significance of a the plaintiff choosing to wear a "Bates Motel" shirt"? .... "I see.... can you give me a citation to the medical literature that supports that opinion" and so on and so on ad nauseam.

Having seen a young colleague reduced to tears in court by being cross examined on the meaning of "GRST"* in the notes she made, its a fair warning.

GRST= "Guardian Reading School Teacher". The Guardian is a Liberal, leftish Brit Newspaper that leads the charge on issues such as complementary medicine, the iniquities of the medical profession etc. I'm sure that there is a species of heartsink patient similar to the GRST in the US. Probably the incidence is quite high in California.

Ed Adams said...


(Not to take over Dr.G's blog here, but:)

I have heard many docs say the same rule of thumb about dictation as you suggested.

And YES, we have a similar scenerio as your Guardian Readership over here. Except, we call it.....Readers of the Medication Package Inserts.


Patient: "Doctor, the insert for this medication says that 1% of patients experienced Vaginal Bleeding."
Doctor: "I really don't think that's going to be an issue, SIR!"

Doctor D said...

I would imagine the presence of a "Hell -Cayman Islands" shirt would indicate some deep problems in this patient's brain. Neurologically balanced people don't wear tacky stuff like that!

Anonymous said...

Not to take over Dr. G's blog, but Medication Package Insert Readers are a peculiar bunch. I would make sure that they receive several package inserts if they request one, i.e. so that they can sort through and compare the < 2% incidences. In my experience. I've noticed a tendency to overwork, or sprout new neural pathways with just one insert, and when they call on the phone it's less of a hassle for the pharmacist to haggle over specifics, unless your patient just happens to have it memorized.

I have to laugh, in recalling that obviously in the face of complaints of too much fine print in PPI (Patient Package Insert) documents, one company increased the font to the size set for the legally blind. Holy, Smoley, with the size of one these package inserts for a chemo I was compounding, one could wallpaper a small room.

Rx Intern said...

Hey! You never know...he could've gotten something at Bates Motel...but not neurological at all, if you get my drift.

Beloved Parrot said...

Well, I finally understand why visits to the neurologists can be so expensive. Thanks, Dr. Grumpy!

TranscriptionistTia said...

I have an appointment with my neurologist this Friday. Now I have to figure out which T-shirt to wear! Should I go with "Don't drink from the hot tub" or "I woke up for this?!?"

j said...

I'd start getting scared if he wore an "Overlook Hotel" shirt next.

Qex said...

Maybe that report came from the Neurology office this medical student did her last 4th year rotation in? http://cutonthedottedline.wordpress.com/2007/03/19/nightmare-office/

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