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Acing the Mini-Mental Status Exam

Posted Dec 12 2008 3:43pm

This morning I wake up thinking about a yellow shoe hanging from a pine tree, and I decide to write this blog.

It is September 12, 2007, and I am at the University of Colorado Medical School in Denver (you'll understand why this date and location is important later). I glance around the small room packed tightly with twenty people, all with various movement disorders. Many of us show wear with signs of living with Parkinson’s Disease for many years, with our shaky limbs and masked faces.

I recognize many of the “formers”: a chairman of a university math department, a director of a university computer science department, an engineer, an attorney, a clinical psychologist and me, a contradiction with a CPA and Master’s degree in Social Work. I’m accustomed to being accused of being a sensitive accountant and teased about being a logical social worker. In our roles as “formers," we previously had occupations and careers that dominated our lives, but now are available on a Wednesday morning, to be interviewed by second year medical students, most as young as our children and grandchildren. The University of Colorado medical students interview volunteers with movement disorders to find out what it is really like to live with Parkinson’s, Essential Tremor or other disorders that affect our mobility.

My name is called, and I am greeted by a medical student, who introduces himself as John. His professor mumbles something when I ask his name, and he clearly does not want me to know or address him by his first name. After all, he is a Doctor.

John and Doctor whisk me away to a room with about a dozen eager 23-year-olds sitting in a semicircle. These medical students introduce themselves by their first names, and their two professors have the same first name of Doctor.

The students ask perceptive questions such as how did I feel when I was first diagnosed with PD, what are my biggest fears about the future, and how does PD affect my husband and family. I have both too little to say and too much to say within that hour. When I tear up, some of the young students are also misty. I secretly ask myself why the neurologists never ask me these kinds of questions. Then I realize that these medical students are currently studying psychiatry not neurology. I wonder if the students would be comfortable asking the same questions if they were currently studying neurology instead of psychiatry.

When the students seem to run out of questions or not get the answers they were hoping from me, John asks questions from the Mini-Mental Status Exam. This exam quickly measures five areas of cognitive function: orientation, registration, attention and calculation, recall and language.

I didn’t tell the young students that I previously endured eight hours of neuropsychological tests to be approved for Deep Brain Stimulation (DBS) surgery. Surgery candidates for DBS are not allowed to be demented, disoriented, depressed or deficient. DBS can sometimes make these characteristics worse (see Imperfect Then, Imperfect Now ).

John says “shoe, yellow and pine tree” and asks me to repeat. I repeat “shoe, yellow and pine tree.” I visualize a yellow shoe hanging from a pine tree.

John asks me to count backwards by 7 starting from 100. I chuckle as I tell him that I discovered the trick to solving this puzzle. “Instead of thinking in terms of subtracting by 7, it’s easier if you subtract by 10 and add 3,” I instruct like an elementary school math teacher. For example,

100 minus 10 equals 90 and 90 plus 3 equals 93,
93 minus 10 equals 83 and 83 plus 3 equals 86,
86 minus 10 equals 76 and 76 plus 3 equals 79,

John concurs that “You got it,” and Doctor questions why I told the students how to solve this trick question. I can’t picture these bright doctors of the future ever having to answer this question.

John asks about the three words that he mentioned earlier. I respond with “shoe, yellow and pine tree.”

John asks another trick question: “Where are you?” He hears irritation in my voice when I respond with “Ninth Avenue and Colorado Boulevard in Denver, Colorado.” John sheepishly says, “Oh yeah, you said that you worked across the street at the hospital for seven years.”

After the interview is over and I leave, I realize there is so much that I didn’t say.

For those young doctors-to-be who might be reading this blog, this is what I want you to know:

Don’t ever be afraid to be sensitive to your patients. Ask them questions. Get to know them as people with multi-dimensional lives, not just patients with problems.

Really listen to your patients, not only their words, but also the feelings behind their words, the challenges behind their smiles and the fears behind their tears.

And most of all, never give up on your patients. If you lose hope, they will perceive your hopelessness. It is okay not to have a solution to their medical problems, but it is unacceptable to dump them without a referral to someone who may be able to help.

That’s all that I need to say. I feel much better now.

I hope that I aced the Mini-Mental Status Exam, even though I can't get the yellow shoe hanging from the pine tree out of my mind.

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