Sign in to follow this  
Followers 0
danher

Surgeons and MSE

28 posts in this topic

Just read the thread below about the referral from surgeons which raised an important question about whether or not surgeons should be expected to be able perform MSE. Most people were of the opinion surgeons should be able to do this and have no excuse not to be able to do so. I would look at it from a different point of view. When I worked in Liaison psychiatry, if I got a referral from surgeons I would see that pt ASAP, even if it was for depression. We may expect surgeons to be able perform a competent MSE, but the fact is, they can't. We have a duty to the patient, which is to perform the MSE ourselves rather than leave them at the mercy of the surgeon. I was asked to see a lady with 'depression'. It was obvious in 1 minute she was delerious. The jaundiced face and eyes made me think it was probably due to liver disease. Her flapping tremor confirmed this. In fact, as I was speaking to her she was bleeding out into her nappy. She died a few days later. I had delayed the ward round to see her and was glad i did as she got transferred to ITU that morning, albeit too late. Point being, we owe it to the patients to see them ourselves. Our medical and surgical colleagues couldn't care less about psychiatric problems and although medicolegally they will be the ones accountable, ethically, we owe it to the patient to do what we are most skilled at doing.

Share this post


Link to post
Share on other sites

Sorry,

Which thread?

Share this post


Link to post
Share on other sites

I think I would have been depressed if that was the standard of care I was getting.

Share this post


Link to post
Share on other sites

I think to some extent I'd agree with danher. I've heard several people say doing a mental state examination is part of the final MB therefore all doctors should be able to do one.

Fine but by extending this logic all doctors should be able to examine pregnant women; take a full paediatric history and give several differential diagnoses for unilateral deafness.

Surely the point is to act within your competencies and know your limitations. If other disciplines want help with a mental state examination I'd normally be very pleased to respond. It is the main area where we can show off our skills.

Share this post


Link to post
Share on other sites
I think to some extent I'd agree with danher. I've heard several people say doing a mental state examination is part of the final MB therefore all doctors should be able to do one.

Fine but by extending this logic all doctors should be able to examine pregnant women; take a full paediatric history and give several differential diagnoses for unilateral deafness.

Surely the point is to act within your competencies and know your limitations. If other disciplines want help with a mental state examination I'd normally be very pleased to respond. It is the main area where we can show off our skills.

Share this post


Link to post
Share on other sites

I think the point was whether surgeons should be able to do an MSE. I was arguing they shouldn't necessarily be expected to, in the same way I wouldn't feel particularly competent at, say, examining a pregnant woman.

Share this post


Link to post
Share on other sites

we ourselves learn to do an MSE lifelong..

wont be surprised!

Share this post


Link to post
Share on other sites

All doctors (surgeons included) should be able to do a basic MSE. I wouldnt expect them to weed out all first rank symptoms but surely they should be able to distinguish depression from delirium.

As psychiatrists, we must be able to do a basic surgical examination.

Share this post


Link to post
Share on other sites

the issue here is not taking the time to do an examination but rather to be able to come up with a reasonable differential and actually do something helpful for the patient.

sure a surgeon could do an MSE it wont take more than 5 minutes and its hardly rocket science however what are they gonna do with that information

whats the point in asking them to do it unless they can follow on from that with some treatment. What we can offer is experience they haven't had, you just can't learn the stuff we know in a book.

Let surgeons be surgeons for the patients sake

Share this post


Link to post
Share on other sites

This post is speaking about a patient with a serious medical condition though. Fine don't expect surgeons to do a very good mental state, but expect them to know how to spot a moribund patient...

Also do you really think they should do no MSE, and call us for advice about every odd patient they see? MSE is necessary in order for us to triage our assessments on-call, we can't just rush off and see everyone that they want us to see because they cannot distinguish between common psychiatric disorders.

Do you think that a surgeon would accept a referral from us saying 'oh yes I think they've got an acute abdomen, but I haven't done any examination of them. Can you come and see them?' Why should we expect them to get away with it? After all psychiatric conditions are far more commonplace than surgical ones...

Share this post


Link to post
Share on other sites

I agree Chris. Although rather than 'let them get away withit' I think the triage point is correct. Of course the final diagnosis and management is for the experts but immediate management, further referral (if needed) and completion time need basic info. I feel that surgeons don't like to comment on even that and would lke us to takeover a 'odd' case altogether, if there is nothing acute.

Share this post


Link to post
Share on other sites

We are expected to conduct examination of a thyroid condition (among various other medical/neurological/ophathalmologic examinations) on MRCPsych Part-1 OSCE... Similarly do they need to do an MSE in part 1/2/3 MRCS?

Share this post


Link to post
Share on other sites

only in part 1 I think....!

:lol: :lol: :lol:

Share this post


Link to post
Share on other sites

Doctors who can do a competent MSE and a competent abdominal exam....that's the definition of a general practitioner, isn't it? ;)

Share this post


Link to post
Share on other sites

No, that's the definition of a doctor.

Share this post


Link to post
Share on other sites

One of my friends who is an Orthopaedic SHO thanked me for sending the mnemonic for mini-mental state examination which they have to regularly do for elderly people with fractures. Apart from MMSE, I agree that they should also know the ABC of the rest of the MSE. Sometimes even a patient delirious due to a medical cause is also operated upon by surgeons who either don't do an MMSE.

Share this post


Link to post
Share on other sites
One of my friends who is an Orthopaedic SHO thanked me for sending the [highlight]mnemonic for mini-mental state examination [/highlight]which they have to regularly do for elderly people with fractures. Apart from MMSE, I agree that they should also know the ABC of the rest of the MSE. Sometimes even a patient delirious due to a medical cause is also operated upon by surgeons who either don't do an MMSE.

Share this post


Link to post
Share on other sites

Not sure, but I tend to use ASTHMATICS

A - Appearance

S - Speech

TH - THoughts

M - Mood

A - AffecT

I - Insight

C - Cognition

S - Suicide/homicide (risk assessment)

Tends to keep me right....

Share this post


Link to post
Share on other sites

The above one is a good mnemonic for mental state and for the minimental state exam, folllowing will be the mnemonic.

ORAL

Orientation

Registration & Recall

Attention & Calculation

Language (Two things to write or draw, two commands to follow [3 stage and close eyes] and two things to speak out i.e. tongue twister and names of things.

Share this post


Link to post
Share on other sites

Surgeons are best left doing surgery.

I carry out a lot of Old Age Liaison work and I think it is worthwhile seeing all patients who trouble our surgical colleagues, as they know enough about the MSE to be slightly dangerous.

Most patients end up with a diagnosis of delirium, and explaining the management to the surgeon, as well as the fact that early recognition and treatment leads to a shorter hospital stay is usually enough to make them more aware of the condition. And fewer referals in the future.

Share this post


Link to post
Share on other sites
Not sure, but I tend to use ASTHMATICS

A - Appearance

S - Speech

TH - THoughts

M - Mood

A - AffecT

I - Insight

C - Cognition

S - Suicide/homicide (risk assessment)

Tends to keep me right....

Share this post


Link to post
Share on other sites
Surgeons are best left doing surgery.

I carry out a lot of Old Age Liaison work and I think it is worthwhile seeing all patients who trouble our surgical colleagues, as they know enough about the MSE to be slightly dangerous.

Most patients end up with a diagnosis of delirium, and explaining the management to the surgeon, as well as the fact that early recognition and treatment leads to a shorter hospital stay is usually enough to make them more aware of the condition. And fewer referals in the future.

Share this post


Link to post
Share on other sites
Not sure, but I tend to use ASTHMATICS

A - Appearance

S - Speech

TH - THoughts

M - Mood

A - AffecT

I - Insight

C - Cognition

S - Suicide/homicide (risk assessment)

Tends to keep me right....

but, that's not ASTHMATICS, that's ASThMAICS

Share this post


Link to post
Share on other sites

but, doesn't that miss out things like behaviour and perceptual disturbance/ hallucinations?

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0