Confusing times

Have the people who have devised the “bare below the elbows” policy in hospitals fully considered the impact on the assessment of mental state?

While reviewing a patient on the ward who was confused, I completed the physical examination and drug chart review and naturally turned next to the mini-mental state examination. We passed through the time and place questions, tried and failed to remember three things, and had even managed, after a fashion, to copy interlocking pentagons.

On the home straight, the patient rapidly and correctly identified my pen. I whirled my arm theatrically in the air, bringing my wrist in front of her face to show her my watch. Where was my wristwatch? Of course, along with my shirt sleeves and engagement ring it was removed. Gone, never to be seen in public again for fear of contaminating the hospital. Falteringly, I asked her the question anyway: “What is this?”

Luckily the patient was able to identify my arm. This raises the questions, is it the arm or the wrist the patient should name? Has the test been validated for parts of one’s anatomy? What other objects could be used instead?