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Stuff that Changed our Practices, Part 2

Heidi James, MD, Brandon Grove, MD, and Jordan Roberts, PA-C
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Heidi talks about an online cardiovascular risk calculator that revitalized her approach to dyslipidemia management. She also covers the recent CDC and Health Canada guidelines on opioid prescribing.  Jordan, who in the throes of a huge concussion trial he’s working on, focusses his attention Brandon discusses the book that changed his life; Margin by Dr. Richard Swenson and the California Assemly Bill 487 of 2001 that changed his approach to opioid prescription - and not for the better.


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Ian L., Dr -

The VOMS test takes a minimum of 10 minutes and needs practice to do the manoeuvres .
So it does take effort .
Like to see a modified test that would take less time developed .

Heidi J., MD -

From Jordan Roberts, PA-C: Dr. Ian L is correct - performing a VOMS assessment does take practice and effort, and with anything, it takes time to recognize the subtle signs that may make you more or less suspicious for a concussion. However, I'm not so sure about the ten minute estimate - there are seven movements, but including getting a quick 'baseline' symptom level, I've never had the test take more than two minutes even if I am really taking my time for whatever reason (maybe I've got a stat consult for pseudoseizures blowing up my pager just outside the room). Perhaps the listener is thinking of a different examination, or in using the VOMS for a different purpose? It is worth noting that I am only discussing the VOMS in relation to concussion assessment, and your mileage may vary for other conditions. The citation for the article in question by Mucha, et al is below. If you scroll down to appendix 1, you'll find a good explanation of how to perform this examination. If I'm missing something and it turns out that it really is a ten minute test, I'd happily change my point of view and insert my foot in my mouth. Let me know if there are any other questions or further discussion!

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Jingle, Jingle Full episode audio for MD edition 178:44 min - 84 MB - M4AHippo Primary Care RAP - December 2017 Summary 310 KB - PDF