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Neurology Survival Guide for Registrars

CLINICAL  ASSISTANTS:  

Job Description

Ward:

  • Daily notes
  • Complete a Neurology Admission Book on the day that the patient is admitted.

Clinic:

  • Commence morning clinic at 8.30 (Monday) 9 am on other days
  • Commence epilepsy clinic at 12.45 pm.
  • Present all patients to the supervising consultant.

Call:

Weekdays:

  • F1: Start at 7.30 or earlier:
  • Go through all the cases in F1, identifying all Neurology cases.
  • Prepare stroke forms for all strokes
  • Present one case (as dummy)
  • Ward referrals: see all referred cases and discuss with referral consultant

Weekends:

  • A8-West: daily round to see all the cases, making notes.
  • Daily round in F1, as in the week.
  • See any other patients if requested by F1 registrar.
  • Call consultant on call for help whenever you need it.
  • Arrange with consultant on call for appropriate time to review cases: note that this must not clash with Monday morning clinic, which starts at 8.30 am.

Bookings

  • Urgent bookings:  F1 or direct to ward (discuss with consultant)
  • Semi-urgent: next clinic (5541) or Wednesday new patient clinic (also 5541)
  • Monday Clinic:  General Neurology
  • Tuesday Clinic: Epilepsy
  • Wednesday Clinic: New Cases
  • Thursday Clinic:  Neuromuscular/ Movement Disorder.

1.      The following problems are recurrent and need to be avoided:

Failure to prepare the patient properly for presentation on the ward round.

Preparation means that you perform a detailed history and careful examination on the patient, obtain relevant and important background information, which means, at the least, microfilms, clinic records and ward summaries, if such exist.  Ward summaries are always available: ask Mrs. Louw, the Neurology secretary, if they are not already present in the folder.  At the end of your presentation, you are expected to provide a reasonable differential diagnosis and a reasonable approach to future investigations and management.  Your summary of the patient’s history and examination must be written down in the neurology clerking book.  

2.      Failure to complete summaries on time.  Summaries of patients who have been discharged should be available within 5 days after discharge.  This is for two very good reasons:

(a)  in order that the relevant consultant can recall the details of the patient, and

(b) in order that the summary is available for the patient’s follow-up in the clinic.

3.     Failure to complete discharge notes.  All patients must obviously obtain a discharge note indicating what medicines they are taking and what the current plan is.  This should be completed on the ward round in the presence of the team at the point in time that the patient is discharged.

4.    Presentation order.  The examination should be presented in only one way, and that is as follows: cognitive function (if indicated), cranial nerves, motor system, sensory system, coordination stance and gait.

5.    Each and every patient must have an admission note and a Neurology book: whether they are transferred from another ward, taken up from F1, etc.

6.     F1 rounds.  The registrar who is on call should take care of F1 from 7h30 to

Identify and locate which patients need to be seen.

7.     During the ward rounds, please correct your history and examination findings if there are changes, as found by the consultant.  Together with the consultant draw up a differential diagnosis and plan.

ADMISSIONS

Empty beds are a waste of tax-payer’s money.

Neurology is a tertiary referral unit: many of our admissions are cold, or are admitted because they are old patients who “belong to us”. Every attempt will be made by the consultant to admit appropriate cases to the Neurology ward.

Admissions are at the consultant’s discretion.

Strokes are sometimes admitted entirely for nursing care or to relieve the family of the burden of caring for the acute stroke patient.

Academic meetings:  we go to Groote Schuur for a combined meeting at 11:30 on the 4th Friday of the month.  On the 2nd AND 3rd Friday of the month there will be meetings in our seminar-room.  On the 2nd Friday of the month at 08h30 we have a combined meeting with UCT.

On the 1st Friday of the month we go to Worcester Hospital:

Evidence based Medicine Journal Club takes place on Tuesday at 4pm.  Journal Review takes place on Wednesday at 2 pm.

OUTPATIENTS

See schedule.  Be punctual, meaning 08h30 am on Monday. All cases are to be discussed with the consultant.   

LP CLINIC

The registrar on call on Wednesday is responsible for occasionally doing LP s on outpatients.  The reason for the LP and the results should be included in a subsequent summary by whoever was responsible for doing the LP.

JOURNAL CLUB

All meetings on your roster are obligatory.

SECRETARY

Under no (absolutely none) circumstances are you to bother the secretary with personal typing.  This includes your skripsie etc.

PUNCTUALITY:

Please do not be late, especially for F1, and for clinic, which starts at 8.30 or as close to that time as possible

TEACHING

Apart from the usual bedside teaching, you must complete assignments ( see attachments). These must please be handed in by Friday morning of each week.

You MUST write down your answers. They will be marked.

Week 1: Localization

Week 2: Brainstem

Week 3: Epilepsy

Week 4: Dystonia and Myoclonus

Week 5: Basal Ganglia, Memory & Frontal Lobe

Week 6: Parkinson’s Disease

Week 7: Cerebellum

Week 8: Spinal Cord & the UMN syndrome

Week 9: Stroke

Week 10: Autonomic

Week 11: Sleep

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