Choosing a Neurologist
Once a patient has been diagnosed with MS, it is important that she finds a neurologist with whom she is comfortable. After all, most patients live 30 to 40 years after their diagnosis, and a patient diagnosed at age 20, can expect to live at least 60 years with the illness. Where I practice in New York City there is no shortage of neurologists who specialize in MS. However, in less urban parts of the country, patients may have fewer options.
If a patient has the option of seeing a neurologist in a specialized MS center, I think this is generally advisable. While most general neurologists are able to handle basic, non-complicated cases of MS, they may not be so comfortable using the newer, more aggressive treatments such as Tysabri. And I have little doubt within the next few years, the number of medications available to MS patients will increase significantly. This is certainly good news, however the management of MS will be more complicated with so many more treatment options. Additionally, most MS centers can offer “one stop shopping” with MS-trained nurses, psychologists, social workers, and occupational/physical therapists all under one roof. For patients with mild MS, these services might not be necessary, but for other patients they are essential.
Another factor to consider when seeking out an MS doctor is how aggressive that doctor is in treating MS. All doctors do their best to balance the risks of the various treatments for MS with the possible benefits. Different doctors do this in very different ways, however. There are well-respected MS specialists who have a reputation for being very conservative. They obey the medical dictum of “first do no harm” and are reluctant to use any treatment that hasn’t been thoroughly proven through the appropriate scientific studies. Other doctors are more willing to try experimental, unproven treatments, especially in cases where their patients are clinically deteriorating. The approach of these doctors is that it is better to try something rather than nothing, especially if patients are deteriorating rapidly. There is no “correct” answer about how to balance these two approaches, and ultimately patients will have to decide which approach feels more comfortable to them.
It is important the MS patients feel personally comfortable with their doctor. Most patients with MS will get to know their doctors quite well, and the opportunity for me to get to know my patients over many years is one of the reasons that I chose the specialty in the first place. Patients need to feel comfortable talking with their doctor about potentially uncomfortable topics, such as their sexual function and bathroom habits. Also a patient might not agree with a treatment proposed by their doctor. Patients should feel comfortable expressing this without fear that they are going to personally offend their doctor in any way.
Finally, patients should always feel free to seek a second opinion. I let my patients know that there are a variety of opinions on any problem they might face and hearing a range of opinions is rarely a bad idea. Ultimately, patients should try to find a single doctor they know and trust and with whom they can develop a long-term relationship.
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