This is fascinating due to (a) diversity of human behavior, normal or abnormal, b) the challenge - in my eyes - of clinical observation in the face of distractions (e.g., tomato paste in hair), and (c) the seemingly magical result possible of correctly determining treatment. It seems an impossible task and thank God there are people like you who embrace the task. Looking forward to future posts.
One of my former colleagues tricked me when she said, “I only work from the neck up!” I thought, well heck - behavioral health should be a lot easier and cooler than memorizing all the things one must learn about the rest of the body…oh how wrong she was! That brain is one complex organ!!! Glad you are amongst this difficult trade.
A clear and balanced approach. Helpful and interesting. I heartily agree with your remarks about the initial evaluation--all too often we're too quick to think we know. As an analyst I've seen for supervision likes to say, "Intakes—taking in who someone is—can take months or years."
to this era? This generation of nursing students have no idea what these sayings mean (comprehensive MSE): A stitch in time saves nine; A rolling stone gathers no moss.
I was never a big fan of asking patients about various proverbs. It isn't clear what the purpose is—abstract reasoning? familiarity with the culture? If people want to ask, it's probably best viewed as a kind of Rorschach test, where you're just observing how the patient thinks. But the proverbs used should be familiar ones in common use. There's no "official list" somewhere, so I'm not sure why the same ones keep getting repeated. Maybe it's just unthinkingly passed on down the years. Personally, I think a better route is to ask the patient to reason about something relevant to their current circumstances.
I agree, I’ve never actually seen/heard anyone use those in a ‘real life’ MSE. (But Its a fun class activity as older students explain to the younger ones. Which leads to grandparent stories, students from other cultures share their experiences, and so on.)
The problem is that it can be heavily dependent on whether you’ve actually heard the expressions before. IMO there are better ways to test this kind of thing.
1. Editorial: it's not obvious at first to a lay audience that this describes an in-patient evaluation
2. Lay audiences may react poorly due to a perception that the experience is socially judgmental. I was offended recently when my PCP noted my disheveled appearance. It was, but struck me as rude given that we were discussing DM2 treatment). I've been seen by psychiatrists in office settings for a quarter century. I first went for an urgent reason, but if it had been more of getting sick of being depressed all the time I thjink I might have been put off.
As a medical student, that's a terrible MMSE list to try and remember... I seem to remember ASEPTIC was a popular shorthand, and I think I used something that started A, B, C etc If you've got a cheat to remember it, let me know... You're the first person I've seen list Idiosyncracies though, that's not something we were taught.
The MMSE is the mini-mental state exam, which is different than the MSE. I didn’t lay out the list for the purposes of med student memorization, rather to present a thorough mental status exam. It’s the kind of thing you don’t need a pneumonic to remember once you do it regularly.
This is fascinating due to (a) diversity of human behavior, normal or abnormal, b) the challenge - in my eyes - of clinical observation in the face of distractions (e.g., tomato paste in hair), and (c) the seemingly magical result possible of correctly determining treatment. It seems an impossible task and thank God there are people like you who embrace the task. Looking forward to future posts.
Thanks for doing this. Looking forward to the sequels!
One of my former colleagues tricked me when she said, “I only work from the neck up!” I thought, well heck - behavioral health should be a lot easier and cooler than memorizing all the things one must learn about the rest of the body…oh how wrong she was! That brain is one complex organ!!! Glad you are amongst this difficult trade.
The tomato paste in the hair isn't a distraction, but a very pertinent observation; it should not be dwelled on, but definitely noted.
Love these patient stories, looking forward to part 2.
A clear and balanced approach. Helpful and interesting. I heartily agree with your remarks about the initial evaluation--all too often we're too quick to think we know. As an analyst I've seen for supervision likes to say, "Intakes—taking in who someone is—can take months or years."
lmfao realizing i am not a very exciting patient; on the other hand, depakote worked well enough for me so maybe I’m easier!
Have these questions been updated
to this era? This generation of nursing students have no idea what these sayings mean (comprehensive MSE): A stitch in time saves nine; A rolling stone gathers no moss.
I was never a big fan of asking patients about various proverbs. It isn't clear what the purpose is—abstract reasoning? familiarity with the culture? If people want to ask, it's probably best viewed as a kind of Rorschach test, where you're just observing how the patient thinks. But the proverbs used should be familiar ones in common use. There's no "official list" somewhere, so I'm not sure why the same ones keep getting repeated. Maybe it's just unthinkingly passed on down the years. Personally, I think a better route is to ask the patient to reason about something relevant to their current circumstances.
I agree, I’ve never actually seen/heard anyone use those in a ‘real life’ MSE. (But Its a fun class activity as older students explain to the younger ones. Which leads to grandparent stories, students from other cultures share their experiences, and so on.)
Isn’t the point that you’re supposed to be able to,figure it out if you don’t know what it means? It’s a reasoning exercise.
The problem is that it can be heavily dependent on whether you’ve actually heard the expressions before. IMO there are better ways to test this kind of thing.
Two comments
1. Editorial: it's not obvious at first to a lay audience that this describes an in-patient evaluation
2. Lay audiences may react poorly due to a perception that the experience is socially judgmental. I was offended recently when my PCP noted my disheveled appearance. It was, but struck me as rude given that we were discussing DM2 treatment). I've been seen by psychiatrists in office settings for a quarter century. I first went for an urgent reason, but if it had been more of getting sick of being depressed all the time I thjink I might have been put off.
Great rundown.
As a medical student, that's a terrible MMSE list to try and remember... I seem to remember ASEPTIC was a popular shorthand, and I think I used something that started A, B, C etc If you've got a cheat to remember it, let me know... You're the first person I've seen list Idiosyncracies though, that's not something we were taught.
The MMSE is the mini-mental state exam, which is different than the MSE. I didn’t lay out the list for the purposes of med student memorization, rather to present a thorough mental status exam. It’s the kind of thing you don’t need a pneumonic to remember once you do it regularly.
I memorized the MSE as a mnemonic, like a pirate saying ABAST MI OJ (Avast me eyes):
Appearance
Behavior
Affect
Speech
Thought process/content
Mood
Insight
Orientation
Judgment
It's a terrible order and it leaves a couple elements out, but you can't beat a pirate mnemonic!
Few medical tools are as powerful as mnemonics, I must admit.