The use of the ice pack test in myasthenia gravis

Hospital can be a very frightening place for patients. As clinicians we can become complacent to the trepidation that some patients face on a daily basis as we move from patient to patient in our clinical comfort zone. One of the biggest fears that patients are subject to is the anticipation of potentially painful and invasive clinical investigations. As empathetic, caring doctors we attempt to make each of our investigations as painless and non-invasive as possible, but even the simplest tests can involve seemingly minor intrusions for some patients. Some of our most ‘non-invasive’ radiological tests can involve the use of the dreaded needle, and needle phobia affects around 10% of all patients seen. So the ideal investigation should be non-invasive, painless, cheap, have good sensitivity and specificity, and be able to be performed at the bedside. This case shows the application of one particular bedside test that is often overlooked by health professionals which can be an easily-performed resource to ensure treatable and potentially life-threatening conditions are not overlooked.