Okay, it’s 4 o’clock in the afternoon. Do you know where your reflex hammer is? Do you even own one, or are reflex hammers just one of those things that should be part of the standard doctoring junk in the drawers of some (but, frustratingly not all) of the exam rooms in the clinic where you work? If you do own one, where did you get it? The last time you handled your reflex hammer, had the once-soft head ossified? And, now for the big question: Do you even care where your reflex hammer is hiding?
Several years ago, I wrote you about my long and deeply emotional relationship with tongue depressors. For 40 years, there was scarcely a waking hour that I wasn’t carrying at least one of these indispensable birch beauties over my heart in my shirt pocket. Throat sticks were a badge of my professional status, and I used them as much as a one-piece Leatherman (could be Swiss Army or multitool if you are uncomfortable with brand names) as I did for depressing tongues. Now that I no longer see patients, I always have a throat stick within reach to stir paint or shim the many poorly crafted D.I.Y. projects I have foolishly tackled.
On the other hand, I never grew very fond of my reflex hammer. In fact, I have never had much use for it. When I was a first-year medical student, most of us were short of money and even shorter on concerns about conflict of interest. Drug companies were eager to imprint their names on our pliable minds. We were offered nice black leather bags and stethoscopes. I still have and regularly used my Littman stethoscope. After many tubing replacements, the head no longer swivels to the bell position, which I never found very helpful anyway. In the bag was a reflex hammer with “Lilly” stamped on the silver-colored handle.
I’m not sure how many years of unsuccessfully trying to consistently elicit deep tendon reflexes passed before I finally gave up. But it wasn’t many. In a general outpatient pediatric practice, there are very few situations that I felt I needed to know about the patient’s reflexes. Certainly, I didn’t see that they needed to be included as part of a health maintenance exam of a child with no complaints.
But every now and then a patient would complain, “Hey, you didn’t hit my knee with that hammer thing.” If they pleaded long enough, I would go hunting for one in a drawer. I didn’t want my patients to leave the office feeling that they had been cheated out of a full exam. If I couldn’t find a hammer, which happened more often than not, I would use the edge of my stethoscope as my tendon whacker. Maybe that’s why the old friend stopped rotating. If I had time, I would use the hammer or stethoscope edge to tap on the tendon of the forearm muscle that extends the middle finger. The result was particularly amusing to the preteen boys.
Of course, once every month or 3, I would encounter a clinical situation where knowing the status of the patient’s deep tendon reflexes might, just might, help me make a diagnosis. Obviously, if I had been a hospitalist, neurologist, or emergency department physician, I would have used a reflex hammer often enough to keep one handy. But, for me, the reflex hammer has been relegated to the drawer of miscellaneous stuff that is useful in eliciting memories, but that’s about it. Oh, by the way have you seen your head mirror lately?
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping With a Picky Eater.” E-mail him at pdnews@frontlinemedcom.com.
