Journal Article

AB1266 JOINTS STILL PLEADING FOR ATTENTION

Lee, L. H., Arora, P.

2020

Overview

Background:Despite the prevalence of musculoskeletal diseases in an increasingly elderly patient population, musculoskeletal (MSK) examination remains frequently overlooked and poorly completed in medical clerking. Indeed, studies over the years have emphatically demonstrated the widespread omission of MSK examination. (1,2)Objectives:The aim of this study was to evaluate the documentation of MSK examination in medical clerking on the acute medical take. Furthermore, we sought to assess doctors’ perception of MSK examination and to evaluate the effect of GALS teaching.Methods:Medical clerkings of 50 patients in the medical assessment unit (MAU) were reviewed on a single day irrespective of the pathology. Case notes were assessed for presenting complaints and documentation of clinical examination findings. Results of the baseline study along with GALS examination techniques were presented at the departmental meeting. Case notes review was subsequently repeated with the same sample size.Results:Baseline study showed that MSK exam was recorded in only 10% of patients despite 20% of patients presenting with fall/collapse. In contrast, 100% of medical clerkings had respiratory examination, 94% had cardiovascular examination while 94% had abdominal examination documented. Although confidence in performing MSK examination was not felt to be a problem, perceived time constraints was a major barrier.Repeat study with another 50 set of clerkings demonstrated a significant improvement, with 22% of clerkings having MSK examination recorded. However, the quality of documentation of MSK examination remained sketchy.Conclusion:Our study reaffirms the fact that MSK examination remains broadly neglected despite the high proportion of patients admitted with fall or collapse. Although the completion of MSK examination improved following GALS screen teaching, the quality of clinical examination documentation remained inadequate. Evidently, the indifference towards MSK examination warrants prompt attention and action by medical educators and rheumatologists.References:[1]Kwok F, Lee L, Gupta A. THU0598 Can you hear the joints crying? musculoskeletal examination in junior doctors’ medical admission clerkings. Annals of the Rheumatic Diseases 2017;76:432.[2]Lillicrap MS, Byrne E, Speed CA. Musculoskeletal assessment of general medical in-patients--joints still crying out for attention. Rheumatology (Oxford). 2003 Aug;42(8):951-954.Disclosure of Interests:None declared

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: Documentation / Musculoskeletal diseases / Patients / Rheumatology / Scientific Abstracts