The fastest, easiest test of the memory that I know is the one where you have to remember three objects five minutes after you’ve been told what they are.

This is part of a standardized test of cognition (typically testing for dementia) known as the Mini-Mental State Examination (MMSE). Actually there has been more debate of the “what is this test and what objects should be used?” variety than anyone can possibly imagine. It is usually not too tough to engage someone in talking about something else for five minutes, to keep them from repeating it in their head.

Usually an individual preceptor will have their own way of doing it and reasons for choosing the words or objects of ideas they choose, and specific ways to enhance the meaning of the test. And of course, specific lists of words. Also whether or not an attempt should be made to remember them after a bit of prompting. I have a feeling the people reading my assessments are not very interested in prompting. However, the patients certainly are — for by the time we get to this they really want to please me (a lot that helps!!) so I give them some easy prompting, and note what happens. To me, it says something about how close to (accessible) consciousness the memory is. In the quick sort of assessment protocol I am stuck using right now, I have an employer who wants one of the words to be “flag.” Normally (for the past 20+ years) I used ashtray, red rose and pencil — so I fumbled around with hints for a flag.

I also do the MMSE in Spanish. Nobody said I had to, but my Spanish gets better by the hour and I want to bond with my patients, as opposed to their bonding with the translator whenever they can. In Spanish, the word for flag is “bandera.” If a woman cannot get it, my clue is ” Antonio el guapo.” “Handsome Antonio.” No women seem to miss it with this clue. That says something — although as a gringo of another generation, I wonder if Señor Banderas is related to Fannie Flagg. Although they used to sometimes get it with “symbol of a state or nation,” my English speakers almost always get it when I mime waving a flag and hum a bit of “Stars and Stripes Forever.” You have to be careful with patients, though. One man, born in Boston, said he preferred the finale, from the Arthur Fiedler version, which I happen to be quite familiar with. I had to conduct it with both hands, so I could not mime a flag-waving. My Father-Of-Blessed-Memory, a composer and conductor among other things, would have been proud. The next patient told me that the way I do an interview had been discussed in the waiting room, and by patient vote they decided that I was worth waiting for, even though I was running a good hour late.

I felt like Sally Field at the Oscars a couple of years ago. I told the waiting room “You love me! You really love me!” It still amazes me how some people can get angry at me.

I think it is mostly because I prefer to relate to them like a human being listening to their problems. Being an authority, even giving a brief oral test which I tell them I did not write can easily make people angry. So much of life is points and scoring. Sometimes people remember wrong words that I never said. A couple of people have said “bear” instead of flag. It made no sense to me until an angry woman told me. “There is a bear on the California flag, so you got to give me points for that.”

There is indeed a bear on the California flag, which flies over many places, including the one where I am staying right now.

I told her this was not a point thing, and she had no worries. I still could not count “bear” for “flag,” but I would note what she said. She told me a little about her history, being California born, and one of the “people of the bear…” She told me to check out the history. Sounds pretty arbitrary to me, the decision made up north to capture something manned with Spanish speakers, when people had been getting along pretty well, previously. I have wondered about this sort of thing before, because a lot of people around here speak Spanish and I don’t see a lot of non-Spanish speakers learning Spanish.

As far as I can figure this, in the 19th century we marched west for the nice ocean view. Mexico was bigger. We made about half the people somehow disappear and now nobody wants to learn Spanish, which is not so horrific as English is being learned, more or less well.

The account on the website cited reminds me of the Daughers of the American Revolution I sometimes turned up on the east coast, in my prep school days. Or people who told me in prep school their ancestors came on the Mayflower.
It took me a couple of years to tell them my grandmother of blessed memory came on a much later boat, and had to learn the language, too. The California Flag Bear is really quite cute — They call him “Cubby.” I am not complaining. As far as I am concerned, anything that represents California without a photo of a naked lady movie star is good for points.

As always, the best professors are my patients.

Author's Bio: 

Estelle Toby Goldstein, MD is a board-certified psychiatrist in private practice in San Diego, CA.

Practicing Medicine Since 1981

In her medical career, she has studied in Europe and Canada as well as the USA. She has attended specialty training beyond medical school in the fields of general surgery, neurology and neurosurgery and psychiatry (specializing in psychopharmacology).

Experienced In Many Situations

She has worked in a variety of positions, including:

Medical school professor
General and Orthopedic surgeon
Brain surgeon
Army Medical Corps psychiatrist
Prison psychiatrist
Community Mental Health Center staff
Consultant to a major transplant hospital
Drug researcher
“Whatever It Takes!”

She currently has her own indepenent clinic in San Diego where she is concentrating on what she calls Mind/Body medicine — or Integrative Medicine. Her practice is cash-only, doesn’t accept insurance or government payments, and she operates on the concierge, or “private doctor” practice model to give her patients the absolute best quality of care and the highest level of confidentiality.

Dr. Goldstein’s philosophy is “Whatever It Takes!” Her goal is to do everything possible to solve whatever problem she is presented. This includes seeing patients as quickly as possible — not making them wait weeks for an appointment. This includes making appointments days, nights, weekends or holidays. This includes making house-calls. And it includes using the best, most innovative treatments available — most of which are unknown to standard, mainstream doctors.

Her focus is on transitioning patients away from prescription drugs and onto natural substances. She is also a master practitioner of Emotional Freedom Technique, a powerful and dynamic form of energy psychology that usually brings quicker results than traditional psychotherapy.