The neurologic exam is a critical part of our history and physical when we're assessing a patient. Be it for documentation purposes prior to a surgery, or determining whether or not a patient even needs surgery, the patient's neurologic status and the documentation thereof is paramount in both a medical-legal and treatment paradigm way. As such, although we would like to trust our colleagues on different services regarding their neuro exam, as a neurosurgeon we really have to perform it and document it ourselves. I mean really, what do they know about 4+ versus 4- strength or the bulbocavernosus reflex? One piece of information in particular that seems to be stressed is the digital rectal exam. I'm not sure how many times you need to have had your finger up ...
Nevermind.
In any case, I was called recently to assess a patient with fecal incontinence. Per report there was no rectal tone. Getting a little bit of history made me suspicious that that wasn't entirely true. The guy was in pain, he didn't need another finger up his rear, and surely not right before dinner. But I had to be sure. And sure enough, there was tone. I really really really felt bad for the guy. When you're a patient you've got to wonder, "OK these docs REALLY got to talk to each other so they can COMMUNICATE what's going on up there." You don't get a CT scan everytime a different team wants to look at an image. They should make a portable rectal tone manometer so we'd only have to do it once and it can be objectively documented. But until then, as evidenced today, you can't trust the finger of anyone else's but your own.
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