The first patient of the day was an older woman, taking some neuroleptic drugs, complaining of a tremor. I reported to the attending that I didn’t think she fit the picture for Parkinson’s. Of course, after a five minute conversation with her, it became clear from the questions he was asking that he thought she did have Parkinson’s.

The second patient was a middle-aged woman with very marked symptoms, just on one side of her body. The attending’s conclusion was that she has some weird Parkinson-type disease which for some reason is limited to one side (Parkinson’s does tend to start on one side first, but she had had the symptoms for years with no progression to the other side, which would be very unusual). She was kind of fun because her neurological exam was definitely abnormal, and I was able to find the problems. She also had an abnormal gait, which I could see right away (the receptionist could probably tell, too, it was so bad; but I usually can’t make head or tail of gait problems).

The third patient was an older man with a very classic story and physical exam. I announced to the attending, “Ok, I got it this time, it’s Parkinson’s; do you think we can do something different for the next case?” He smiled and said he gave great thought to arranging teaching scenarios in his office schedule. ;)

I do admire his method of explaining the diagnosis. Rather than plopping right out with the name, which would probably be rather frightening to the patient and their family, he starts with an explanation of the pyramidal, cerebellar, and extrapyramidal systems, and how they’re all necessary for normal movement. Then he says that they seem to have a problem with the extrapyramidal system, which could be caused by a disease like Parkinson’s. So he eases into it gradually, and then quickly goes on to the availability of medicines to help with symptoms and retard progression. It takes about ten minutes for the explanation, but I like it; and he tailors it to the understanding level of the different patients, whether they’re relatively young and work in a medical setting, or older and slightly demented already.