Q: If patients are less disabled throughout their disease course, does this mean comprehensive care is less important now than it was when it began? Do patients still need all the specialized services?Ms. Halper: They need them in a different way. They don’t need as much rehab as they once did. There are still things like bowel and bladder management, and there’s a lot of mental health issues, a lot of education and more focus on wellness.
Dr. Schapiro: From an educational standpoint, comprehensive care is good for all patients with MS. But from a practical standpoint, if you're having more problems, comprehensive care is more for you than if you're having fewer problems. A lot of the specialists we once had in house are now referrals because not everybody needs everything. I don't think every patient who is newly diagnosed needs to see the physical therapist, for example. I don't think they all need to see the occupational therapist. Or have cognitive testing. I don't think they all need that, especially right away, because that'll just shock them. But they do all need education, and that’s something comprehensive care is very good at.
Q: Is the idea to keep patients with these practices all their lives? Ms. Halper: Patients tend to stay with us over the course of their disease. With a comprehensive care center, you’ve got a team that can address the problems that arise when you have an illness that will not go away, will last a lifetime, and despite all the wonderful drugs we have today there’s still that Charlie Brown cloud over people’s heads – it’s always there and it’s very scary.
Q: How have the roles of the different core clinicians – the nurses, neurologists, nurse practitioners – changed in an MS center?Ms. Halper: Nurses are doing all kinds of creative things. We have these programs to educate people, to do things online like yoga or meditation. Especially in the last year and a half a lot of the physical rehabilitation and exercise has shifted online. Many nurses have created programs that have expanded the concept of the Center Without Walls.
Dr. Schapiro: The role of the neurologist has changed too, in that now the neurologist isn't so involved in symptom management. I’m old fashioned; I think they should be. But they’re more involved in talking about the immune system and immune management, and the drugs that are available, instead of talking about how you're feeling and about what symptoms you're having. That said, the treatments don't come without their own set of side effects. Some of them, like the interferons, may exacerbate depression in individuals. The practitioner today must be aware of that and has to be tuned into that.
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