Tempting

Almost there in Neuro placement at Bentley. It is very tempting with time constraints to not assess everything in a Neuro Ax. There is obviously so much to do. I have a had a couple of patients where doing a full Ax and getting information I didn’t think I would do that much with has been turned out to be important. Pt presented TIA? No evidence on investigation. Reduced right sided upper limb voluntary control and diminished light touch and possibly proprioception. Expressive aphasia. Receptive ok. Pt was improving on the ward, main issues were balance unrelated to the TIA? and Gowland 4 arm. Over a period of a few days, aphasia was improving and arm improved to Gowland 5 with minimal PT as pt had refused. So all was going smoothly, good recovery was occurring. I had done a full Gowland on the pts arms as well as most of the rest of the Neuro Ax. The next day pt appears and verbalises he is unwell, aphasia is worse/same but arm has reduced obviously back to Gowland 4. The bells start ringing! Had a chat with my supervisor who suggested a chat with the RMO. As it turns out it was useful information for them as they were currently querying the possibility of another TIA. So in short, if I didn’t assess it, I couldn’t have reassessed it and I wouldn’t have had an objective measure telling me the pt was going backwards. In short I learned don’t cut corners, you never know what info you will need.