GeriPal

The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. However, undoubtedly the biggest reason is that for most of its nearly 40 year life span, it has been free for anyone to use and reproduce, as the creators of the MMSE never enforced their copyright.

Our previous GeriPal post on the MMSE's copyright describes how times have changed:

“This test used to be freely available online, in books, and on pocket cards that were distributed to medical students and residents throughout the country. This all changed in March of 2001 when MiniMental, LLC (the current owners of the MMSE copyright) granted Psychological Assessment Resources (PAR) the exclusive rights to publish, license, and manage all intellectual property rights to the MMSE. Suddenly, after decades of neglect, PAR began enforcing the co…

It's the most wonderful time of the year. No, not because those damn kids jingle belling and everyone telling you "be of good cheer". And not because of those holiday greetings and gay happy meetings when friends come to call. It's the hap-happiest season of all because I just got the BMJ christmas edition in my inbox! 

What, you were not so lucky?  Well, I guess someone is on someone else's not so nice list.  Don't worry though, I'll recap the three key lessons I learned after perusing the issue:

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1) Never write "Stable Vitals" or "Observations Stable" in a Chart 

There are a lot of meaningless rituals that make it into physicians’ notes. One of the most common is using the term “stable” to refer to all aspects of patient care. The most common in the US is the term “stable vitals”. In the UK, “stable observations” takes "stable vitals" place. No matter which you choose, both convey little valuable informatio…

Sometimes the best ideas are so simple that you both marvel at their eloquence and wonder why you never thought of them.

In a perspective in the New England Journal of Medicine, Dr. Dan Wolpaw, a General Internist and Educator at Case Western Reserve University presents a simple and eloquent idea that can transform the quality of medical care and medical education. Dr. Wolpaw suggests we add a portable stool to the equipment we carry on patient care rounds.

Morning walk rounds are a long standing part of medical culture. Teams of doctors walk the halls going from room to room to see each of their patients and develop care plans. But Wolpaw notes that less and less time is spent truly talking to patients. Team members talk to each other outside the room. Then the team approaches the patient, often standing around the patient who is lying in bed. We don't see the patient eye to eye, but literally look down on them. Wolpaw observes that after rounds, the team does take time to sit …

I think we all probably agree that health care providers should give patients with a life limiting illness the option to discuss their prognosis. But what about discussing prognosis with those patients who may not have any particular life limiting illness, but have just lived a long life? Are we as forthcoming about prognosis in this population as we are with a population of patients with advanced cancer? Should we be?

In this week's New England Journal of Medicine (NEJM), Alex Smith ventures outside of the blogosphere to give his perspectives on discussing prognosis with very elderly patients who may not have a dominant terminal condition.  Along with Brie Williams and Bernie Lo, Alex lays out in this perspectives piece the importance of and the barriers to having these types of discussions.

I won't recap the article here, except to restate the overarching recommendation that clinicians should “routinely offer to discuss the overall prognosis for elderly patients with a l…