Question about doctors' quizzing patients to determine neuro status (yes, it's relevant here)

And if the mods disagree, feel free to move this thread.

Anyway, a common question doctors ask patients, at least in the U.S., to test their orientation to time and place is, “Who is the president of the United States?” and I read somewhere a couple days ago (sorry, no link handy) that some doctors have dropped, or at least altered, this question, because of the way some people are responding.

Is this true?

"As an emergency doctor, one thing I cannot take for granted is whether or not a patient is fully oriented. To assess this, I ask four basic questions: What is your name? Where are we? What is the date? Who is the president of the United States? If the person knows all four answers, they are said to be “alert and oriented to person, place, time, and POTUS.” When they get one of the answers wrong, it is good practice to reorient them.

Just by the math of it, several times per week, a patient of mine answers the POTUS question incorrectly. Jimmy Carter seems to be a favorite. Last week I had a patient tell me that Obama was the president. When I told him that Obama’s term was up, he wanted another guess. He went backward to Bush."

You will remember Doc Brown’s reaction to hearing about President Reagan. Apparently that’s how it was for this ER doc under Trump.


Last spring I had to go to the ER thanks to covid. I knew my name and what hospital I was at but I was hazy on the date. And when they asked who the POTUS was my answer was “fucking Trump.” I was the sickest I’ve ever been in my life and scared to death so that’s my excuse. At least they laughed so they weren’t republicans :rofl:

“Today, Mr. tricoteuse, we are all good Republicans”

Probably the 10th time that day they’d heard some variation of that, and glad you recovered.

It is also true in the sense that the turnover of leaders may be too rapid for people to answer accurately. Australia had a bad period of leadership spills across several governments, which led to …

Long ago a friend of mine had mysterious symptoms which could be explained in at least two ways:

  • a condition which included being mentally retarded
  • a combination of Marfan’s Syndrome and sarcoidosis

He actually had the second option, but to eliminate the first the doctor asked him “What’s been happening on the Stock Market recently?”
Fortunately my friend had some investments, so was able to give a clear answer!

An interesting aside is that a combination of Marfan’s Syndrome and sarcoidosis is extremely rare.
So whilst the medical staff explained to my friend what (non-urgent) treatment would be required, they also asked if my friend would wait in the hospital for the rest of the day.
This was so all the surrounding hospitals (this took place in London, so there were quite a few) could send their trainee doctors over to try to diagnose the condition. :cool:

Thank you, and it was some time after 1 am so depending on how long a shift those poor people had been working they were probably punchy enough to laugh at anything!

A slight diversion here - Tony Hancock gives blood in The Blood Donor (1961) - YouTube is part of a hilarious sketch about blood doning.
(It’s very-well known here in England.)

So recently I had to have a blood test (happily turned out to be negative) and I quoted a line or two from the sketch.
The nurse looked at me. “Glee, do you know how many times patients have said those lines to me over the years?”
She wasn’t upset, but I apologised anyway.

I’ve just dropped the question and tell the patient that I’m not going to ask who the President is because people get too argumentative. I also have them draw a clock but I keep wondering how long I will be able to use that test.

Some movie – I can’t remember which – had the following line:

Doctor: Can you name the four seasons ?

Patient: I’m pretty sure Frankie Valli was one of them but I can’t remember the rest.

After working from home for well over a year now, I have no idea what the date is unless I check my phone. The best I could do would be “uhhh, sometime in May? Or is it June yet? 2021, right? I feel pretty sure about the year.”

Wait, I’m confused. How does having the patient write down 4 random digits and draw a rectangular box around them prove anything about their cognition?

Unless of course they decide it’s 36pm. :wink:

@psychobunny – I wonder about this. These days, when you ask a patient to draw a clock, do they often draw a digital clock? Do we have a whole generation of people now, for whom that is the first (or only) kind of clock they think of?

If any doctor asks me to draw a clock, I think I’ll draw a digital clock (complete with 7-segment digits) or clock-radio, just to prank them. Then when they ask me to draw a more classical clock, I’ll draw one and number the hours with Roman numerals. If I had better artistic skillz, I’d draw a sundial.

Right then! Off to the loony bin with 'im!

is the next thing poor @Senegoid heard and we’ve not seen him around here since. Poor guy!

OTOH, when they ask me to count down from 100 by 7s, I can do that accurately and without hesitation – and no, I don’t have the sequence memorized. Counting down by 7s is actually easy, if you know the trick to it.

But repeating those five random words, and then repeating them again after several intervening tasks, that I’d probably have trouble with.

Please, fight our ignorance!

Mentally subtracting 7 each time seems difficult, at least to me. This is likely a detail where YMMV. What works for me is:

If the units digit is 7, 8, or 9, just subtract 7. If the units digit is 0 through 6, subtract 10 and add 3. This avoids ever having to deal with borrowing.

Reminds me of the time I was in my dentist’s office, and made a reference to Zappa’s “Montana” which is a song about dental floss. Unlike in your situation, they’d never heard of it, so I got to be the ones to let them know that there was a song about dental floss, and better yet, it was actually a good song.

Holy crap, you’re right.

And I’m basically innumerate.