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The Waiting Room: neurological observations made outside the movement disorder specialist’s consulting office
  1. Rui Araújo1,
  2. Bart van de Warrenburg2,
  3. Anthony Lang3,
  4. Andrew Lees4,
  5. Bastiaan Bloem2
  1. 1Neurology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  2. 2Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
  3. 3Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada
  4. 4Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
  1. Correspondence to Professor Bastiaan Bloem, Neurology, Radboud University Medical Centre, Nijmegen 6525 GA, The Netherlands ; bas.bloem{at}radboudumc.nl

Abstract

The neurological examination should always begin before the patient enters the doctor’s office. Movement disorders in particular lend themselves to a spot diagnosis. In today’s busy buzzing world, it seems wasteful not to make use of the various diagnostic clues that can be picked up readily while the patient is still in the waiting room. We present several illustrative examples, drawn from the literature and from our own experience. These are divided according to the different waiting room ‘stages’: the patient sitting in the waiting room, the response on being summoned to enter the consulting room—including rising from the chair, exchanging initial pleasantries and the way of walking. We also discuss the importance of paying attention to the patient’s behaviour, clothing, posture, breathing patterns, facial expression and major gait abnormalities.

  • clinical neurology
  • examination
  • movement disorders
  • waiting room

http://dx.doi.org/10.1136/practneurol-2018-002110

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    Footnotes

    • Contributors RA contributed with the review of the existing literature, provided video 1, conceptualised an early framework for the manuscript and drafted an early version of the paper. BvdW provided significant input to early versions of the manuscript, as well as review and critique of later versions. ALa and ALe provided significant input to both early and final versions of the manuscript, adding extensive examples drawn from their own personal experience. BB provided the idea for the manuscript, contributed to its early design, added several examples from his own personal experience, reviewed the final versions of the manuscript and provided the image for figure 1. He also takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Paul Worth, Cambridge, UK.

    • Data sharing statement There are no unpublished data.

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