fellowship

What’s a little dementia between friends?

Clinic appointment request: “URGENT MOVEMENT DISORDERS. Pt needs to be seen in 1-2 days!!!” No additional information provided (like, what’s the consult question, why is this urgent, what’s the relevant history).

Patient shows up on time, but no records, no idea why he’s here. He is nearly blind and very hard of hearing but he can’t see his hearing aids to put them in. Wife, who drove him to the appointment, also is not sure why they are there. I spend 20 minutes going through every possible movement disorder symptom I can think of — too much movement, too little movement, acting out of dreams, loss of sense of smell, trouble walking, tremor, falls, balance, clumsiness, memory — nope, nope, nope, nope, oh wait, memory problems yeah doc I got memory problems.

So unsurprisingly dude ends up scoring terribly on his brief cognitive screen, even accounting for the blind-and-nearly-deaf part. No movement disorders issues at all. So I order a cognitive workup, arrange for him to see General Neurology, and send him on his merry way.

Then I’m at home, writing up his note, and in digging through the chart, I realize that dude was seen by our clinic 3 years ago (well before my time) by the now-graduated fellow, for the same URGENT MOVEMENT DISORDERS consult from the same PCP, and had the same findings. Never did his dementia workup then, either.

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