The role of a primary care physician in multiple sclerosis care should be minimal.
As healthcare adapts to new personnel roles and emerging therapies, the clinician and patient must also adapt. Adaptation—in differing forms—may be what has highlighted the greatest growth in multiple sclerosis (MS) care.
In an interview with MD Magazine®, June Halper, MSN, APN-C, chief executive officer of the Consortium of Multiple Sclerosis Centers (CMSC), explained the change of providers monitoring MS progression, and the increasing awareness of patients.
MD Mag: Would referring to a specialist and monitoring for symptoms be the optimal role of a primary care physician in MS care?
Halper: Yeah, the primary won't be monitoring, but they'll use the clinician that’s a specialist to consult with. A lot the stuff now is in telemedicine. They do it on the web.
I went to a nurse practitioner national conference in Vegas. There were 600 nurses at lunch, believe it or not, and I asked them, “How many of you see people with MS?” Now remember, these were primary care NPs. Most of them raised their hand. So they do manage the patient, and things like symptoms—bowel-bladder spasticity, they can do that. But they're not taking on the DMTs.
It's just like somebody getting cancer: I don't think a primary care clinician would manage chemotherapy.
What has been the greatest advancement in the field of MS in your lifetime?
It's amazing. I still have patients that I'm in touch with that were on the injectables years ago—and I don't want to mention which, because they’re all doing very well. There are some people that absolutely refused to stop injecting.
I have one friend of mine in New York, she will never stop her drug, ever. She doesn't want to take a chance. If she stops it and gets worse, she'll never recover it, you know?
And yet, you see many people going from one to another—as we call them: doctor shoppers. They go from one to another. And there are many people out there that are trying things like stem-cell therapy, as there are places where they can pay for it.
And there are some people that just settle in and become very knowledgeable. They learn about their MS, they take their medications appropriately, they get their blood work, they get their MRIs. We have a very, very, educated population out there, thanks to organizations such as this, where they can log on and learn.
It's amazing that they come in very smart, whereas years ago I remember when I first started taking care of people with MS, the one thing they would say is, “When am I going to end up in a wheelchair?” And it took me the first hour to teach them that the wheelchair may not be such a bad thing—it's a tool, and if you want to hammer a nail into the wall, you need a hammer. And a wheelchair helps you get around.
But those were real concerns. Today, we're seeing fewer wheelchairs, we're seeing a lot more people stay in the workforce, and we see a very knowledgeable and very assertive population, which I'm thrilled about.