MULTIDISCIPLINARY TEAM
The Multidisciplinary approach is a modern way for managing chronic disabling diseases such as MS because of the complexity of this disease, and its progressive nature.
No one single handed professional such as GP or the neurologist can manage MS effectively and efficiently. Multiple specialties with good training and experience in managing MS need to work together in a complementary and integrated way with good inter- communications between all components of the MDT.
Neurologist: The neurologist is the main decision maker, and the central manager of the whole team. The neurologist is the first person who makes the diagnosis and designs the plan for current and future management. The neurologist must be accessed by every member of the MDT either directly or via MS specialist nurses.
General Practitioner: The GP in connection with MS needs to make a speedy referral for any suspicious case of demyelinating disease. The GP also must be up to date in connection with the latest advances in MS management. The GP is by the nature of his/her job is the center of communication between different members of MDT. The GP needs to attend MDT meetings when appropriate, and should have an access with facilities to attend international conferences about MS management.
Psychologist/ Psychiatrist: Depression prevalence among MS patients is about 50% as mentioned in text books and research media, but in reality, the actual prevalence of depression in MS is about 85%. About 35% of patients with MS are in denial about MS disabilities and depression in particular. Those 35% are usually the ones who suffer in silence, and very rarely receive the appropriate treatment.
Psychologists and psychiatrists have a major role to do in connection to MS management as part of MDT. Both psychologists and psychiatrists must liaise with each other, and among themselves they need to decide who sees what and when.
MS Specialist Nurses: I would consider the MS specialist nurse’s role in the second rank after the neurologist in connection with MS patients’ management.
MS specialist nurses (MSSN) must have a specialist training and must have good knowledge and experience in caring for people with MS before they qualify for this role among the MDT.
Patients who are newly diagnosed with a definite MS by one of the neurologists, they are automatically referred to MSSN . On receiving the referral, MSSN will send a contact letter and information booklet about about MS inviting the newly diagnosed patient to contact them if they would like any more information or advice or support in connection to their MS management or coping with.
For patients who are new to the area or new to the service, their general practitioners refer them to the MSSN who then contact them treating them like new patients and give them contact telephone numbers to use when they need any help.
MSSN do also give information, injection training, and deal with patient’s enquirers in connection to disease modifying therapy (DMT). MSSN run a special regular follow up clinics for all patients on DMT.
MSSN do other jobs in connection to MS day to day management including:
- Keeping well and healthy life style.
- Managing MS symptoms when contacted by patients.
- Help in treatments given to patients with MS, such as steroids, DMT, or any treatments given recently and need monitoring.
- Information and support in connection to employment and applying for social benefits for MS sufferers.
- Help and advice for MS patients who are planning for families, during pregnancy, and following that.
- Liaising with both ends of therapeutic spectrum i. e the neurologist and the primary care providers including those in the middle such as physiotherapists, occupational therapists, social workers, etc.
- Facilitate patients’ access to information, organisations, specialist societies, and inter-communications between patients themselves wen applied.
Communications with MSSN is provided via:
- Telephone consultations.
- Nurse-led clinic consultations.
- Home visits when required.