Tuesday, June 27, 2006

lost marbles

A thought struck me this afternoon in the middle of a consultation. Jack is comfortably "over the hill" and in recent years has taking to rambling the byways metaphorically speaking. In short his memory is not what it was. Or so he imagines,though he finds it hard now to remember what it was when it was....

Certainly he has progressed along the continuum from Mildly Eccentric in the direction of Dotty, though he remains a long way from Terminally Bemused. So far his personality, and especially his lively sense of humour are reasonably preserved, but the fine details of daily life increasingly evade him. And now he has reached the point where he, and those around him, have decided it's time for something to be done. So I will be referring him to our very nice and very capable psychogeriatrician-- yes that is a job title and not a pejorative-- for an assessment of his memory. There they will ask him a set of stock questions designed to assess his cognitive abilities and recall.

And this is what has got me thinking. There are days when I am sure my nearest and dearest, and maybe even you gentle readers, having heard me rant on at length about the same old stuff for the nth time since breakfast, begin to wonder if I am starting to meander those same byways. The trouble is, I know all those stock questions almost as well as the clinic chaps do. The answers are now essentaially hardwired so I don't need to "take seven off of a hundred and keep going" to know the right number sequence, and I know perfectly bloody well where John Brown* lives thank you very much! So all I've got to do is memorize the name of the new Prime Minister whenever we get one and maybe those of a few footballers, and I'll be safe if the men-in-white-coats chose to pay a call.

So in years to come just how will we assess the failing cognition of GPs, Psychiatrists and others involved in this field of endeavour?

Do tell. I want a head start swotting for the tests.

* The memory assessment includes the giving of an address to be memorized early in the interview with points scored for recalling the name, house number, street and town concerned at the end. A little psychogeriatric in joke for you there. And at no extra cost.

10 comments:

Cath said...

At our hospital, patients are asked if they know which ward they're on.
I don't think this is part of the mental health tests, I think it's because a) the patients are constantly moved from ward to ward and b) the wards are moved around all the time, too.

I like it best when we get the news that ward A is moving to ward B, but the telephone numbers will stay the same, etc. After this has happened with around one sixth of the wards, we all start to lose track of who and what's where.

So if anyone actually does manage to answer the question 'which ward are you on' correctly, they're doing a darn sight better than the staff.

And 'an apple, an orange and a ball', and '42 West Street'. Or more often a pen. Like you, I'm practising the answers...

wendz said...

Do you know...I puzzled over the use of the word perjorative..I just didn't get it..neither did my dictionaries..(oxford and Collins) neither did the online thesaurus...but AHA! I did find pejorative...sooo...whatever....'scuse me its not me but the vino in me talking...

right then....how to test a medical persona for failing mental capacity...

Q1...aorta...is this part of the heart or is it a question...as in..aorta to be shot, a ort...(referring of course to Tony Blair...oh and Georgie Porgie)...

Q2. A Freud - father of the psychoanalytical school of psychology or mispronouned French term for 'cold'...

and so on and so on...

btw - why do we need to do all this crap? It's clearly obvious when the old goat/goatess is losing his/her marbles and needs to be strapped down 24/7...ahem..sorry Gran...

Doctor Jest said...

cath-- sounds all too familiar. Our local "centre of medicrity" specializes in loosing medical patients on surgical and orthopaedic wards. Bring back Matrons that's what I say. If only to revive the classic tradition of Kenneth Williams impersonation... "Ooooh Maaatronnn!"

Oh and don't go giving them all the address. I need all the head start I can get ;-)

wendz-- I stand corrected. bloody pedantic wine you've got there ;-)

Re the strapping down, is this a French or an African practice. Either way it sound streeets ahead of the indifefrent herding into day centres that goes on here. And has the added benefit that you always know where to find them...
*is going to be in such trouble if this gets out*

wendz said...

Definitely an African thing...my Gran spends part of her day strapped into her bed....sounds barbaric but otherwise she wanders around and hurts herself...and the staff cannot watch her 24/7. She has def def def lost her marbles too, poor old dear.

Shinga said...

Dr. Jest - OT for this post.

As the host of the next Paediatric Grand Rounds I invite you to send in your submissions for the next issue. I'm looking for posts on anything that concerns paediatric health/issues. At the risk of sounding cliched, it takes a village, so I welcome contributions from family doctors, paediatricians, nurses, counsellors, scientists, teachers, parents, etc, etc.

Past issues of PGR are archived http://pgrarchive.blogspot.com/

This is probably more information that you need but the quickest way to establish bona fides is to say that my blog is
http://breathspakids.blogspot.com/

And my reasons for running this project are in this post:
http://breathspakids.blogspot.com/2006/04/why-breath-spa-for-kids.html

I'm particularly taken with your Parental Indignation post and will include that in PGR unless you object or have a different post that you would prefer to submit.

I'm in the UK, so please send your contributions/response by Saturday, July 1, 15:00 London time to give me time to get the Grand Rounds ready for Sunday, July 2.

email: breath.spaATSIGNgooglemail.com

Regards - Shinga

Doctor Jest said...

shinga-- I'm a little stunned. I would be delighted for you to repost the Parental Indignation story by all means. I'll try and see if I can come up with something else if you are in need of material, but knowing there are many better equipped than I, I must admit to feeeling a little intimidated. Also I will now have to go back to the original post and do spell checky things 'cos I know my spelling can wobble :-(.

Good luck with the rounds.

A stunned Dr J.

Shinga said...

Thanks - I really like that post but am absolutely in the market for more if there is a paediatric issue that you are burning to get off your chest.

As for the self-deprecation, you're standing in for Greavsie part-time - is this what he would do?

Regards - Shinga

Doctor Jest said...

shinga-- ah, well , ok. Cue the puffy chest

*witness the undignified sight of the sucking in of bits lower down to puff out bits higher up... henceforth the voice will issue from betwixt clenched teeth*

Is that better?

Z said...

Er - you look amazing. A bit red in the face, but it suits you.

Evidently you were not referring to Jack Woolley, as if you had been you would have changed the name for the sake of patient confidentiality, but he was asked by his doctor to draw a clock face and couldn't remember how. This frankly alarmed me as it is one you wouldn't expect to forget, it not being a short-term memory thing; I assumed it is one of those things that doctors do as surely, in Ambridge, you wouldn't do anything unrealistic.

Doctor Jest said...

z-- Yes I remember the clock face thing.* I don't generally do that one, I think it might be used for "clients" who are rather more far gone and generally -- though not always-- already under specialist care. With us its "serial sevens" Months of the year backwards, the address test, that sort of thing.

Mostly if there's drawing to be done in the surgery I'm the one to do it. Obviously I don't go quite so far as to demand applause Rolf style "C'n y'tell wotitizyit?", but my punters are usually astute enough to know what is expected of them....

*is such a ham*

* how's that for recall eh?