The Problem Every GP Faces

Here’s the truth that makes this question hard to answer at the bedside: not every tremor is Parkinson’s. In fact, the most common tremor you’ll ever see in clinical practice — essential tremor — has nothing to do with Parkinson’s disease. The treatment is completely different. The prognosis is completely different. And the patient’s life changes dramatically depending on which one you diagnose.

The problem is that most GPs were never taught a systematic framework for tremors. We learned “pill-rolling = Parkinson’s” in medical school and stopped there. But what about the old woman whose legs tremble when she stands in a queue but stop the moment she walks? What about the liver failure patient whose hands flap like bird wings? What about the young man whose tremor disappears the moment you distract him with mental arithmetic?

Each of these is a different type of tremor, with a different cause, a different mechanism, and a different treatment. Mix them up, and you either prescribe levodopa to a patient who needs propranolol — or you miss liver failure because you called it “just anxiety.”

What This Guide Gives You

A single, colour-coded clinical note that organises every tremor type into a decision tree you can carry in your head. For each type — resting, intention, essential, orthostatic, physiologic, flapping, and functional — you get the exact bedside test to confirm it, the mechanism in one line, the cause, and the treatment.

By the end of this 7-page note, you’ll be able to watch a patient’s hand for 10 seconds and know which branch of the tree you’re on. That’s the difference between a GP who says “you have a tremor, take this tablet” and a GP who says “your tremor worsens when you reach for objects, which tells me the problem is in your cerebellum — let me investigate further.”

The first approach treats symptoms. The second approach practises medicine.