Patient Work Up and Assessment
One of the most important clues to any diagnosis will be listening to what the patient says when they describe what has been happening and why they have been referred on by their GP. In medicine we call this “taking a history”. Over many years of practice Dr Brennan knows that people will emphasise what is important to them and what has been troubling them the most. Giving the patient the time that they need to describe these things is very important and often can give more information that a written referral or summary can convey. Simply listening and letting the patient talk about things therefore can be a vital key to making a diagnosis and working out a treatment plan.
Often, it is also necessary to perform a clinical examination which is usually the next step of the assessment once the history has been taken. For neurosurgical conditions the examination can vary greatly and is often tailored down to that region or area of the nervous system involved. It may involve an assessment of how someone is walking, what the strength of various movements are, checking reflexes with a tendon hammer, checking vision, memory, speech or other neurological functions, etc.
In most cases these days it will also be important to have some form of medical imaging of the relevant part of the body. For most people this is usually an MRI scan, although not uncommonly combinations of scans and Xrays may be needed. Some of these can be arranged prior to the visit depending on the information in the GP’s referral letter (if not already arranged by the GP). It requires nuance and experience however to interpret the MRI findings in light of the information in the history and examination and to know what findings are relevant. Not uncommonly the MRI may “show things” which are in fact not relevant to the condition at hand and may require no treatment other than reassurance.
Not surprisingly in a field as challenging as neurosurgery a detailed, careful and nuanced assessment in needed to make the correct diagnosis and to sort out what treatment options exist and, when needed, the best type of surgery to be done. The devil is very much in the detail.