At the end of the day, people really want to know what is causing their symptoms and how to manage them. Whether you have definite MS or not, there will always be some degree of uncertainty; uncertainty regarding your risk of MS, uncertainty regarding the risk of future relapses, uncertainty regarding the risk of developing disability and uncertainty regarding your response to therapy, whether it be a drug, a dietary change or a lifestyle change. How you and your physician manage these uncertainties together over time defines the art of the doctor-patient relationship.

If this process doesn’t work for you with your current doctor, discuss it openly with him or her and, if necessary, find a new doctor. Try to figure out what it is you require from a doctor to help you manage your chronic condition. As in the rest of life there will always be compromises you have to make but try to decide what you find to be most essential. Practical issues such as insurance coverage and distance from the doctor’s office are certainly important when it comes to narrowing down the list of doctors to consider, but should not be the basis of your decision.

To me a doctor must first take the time to listen and understand your narrative (doctors call this the “chief complaint”), ask probing questions, explain their interpretation of the information gathered to gain further feedback and information and then put together a plan of action that you are capable of understanding and that clearly addresses your initial complaints. This is much harder than it sounds since often the person describing the “complaint”, is not only unaware of the cause but also unaware of the influence of seemingly random or apparently unimportant aspects of their life on this complaint. 

To give an example, I am often asked by patients to help them with their daytime fatigue, probably the most common symptom of MS. Many patients simply assume they only need a medication for this complaint and have learned that other patients take various medications for their fatigue. In fact, the causes of fatigue are extremely difficult to unravel and require a skilled history and dedicated follow-up evaluations after testing, activity adjustments and possible medication intervention to arrive at a satisfactory solution. As with most problems in medicine this is an iterative process: First, the complaint is identified and understood as best as possible generating a hypothesis that involves further testing or an intervention; second, the patient is educated about the intervention and given the means to carry out the intervention and track the progress; third, the patient is re-evaluated to determine the initial outcome to the intervention and generate further hypotheses leading to further testing or interventions; etc.  This process requires skill, time, empathy and interactive resources.

Anyone with a chronic condition wants to find not only a good doctor but a doctor with the support staff and associated medical professionals dedicated to working together on finding individualized solutions to problems. Here is a link to the NMSS to find a qualified specialist in your area: http://www.nationalmssociety.org/Treating-MS/Comprehensive-Care/Find-an-MS-Care-Provider/Partners-in-MS-Care

In subsequent blogs we will be discussing these issues at length. I will always begin with the importance of education. Simply knowing the facts, or what is not known, is sometimes all that is needed. Where there are choices to be made I will try to outline them clearly, although it may become clear that I have a bias to express. Remember, an unbiased interpretation of data does not exist. What is important is whether the interpretation of the data is consistent with the known facts and your belief system.    

-Dr. Kinkel     

This blog was originally posted in August 2013. We are organizing the site and in order to move the blog we had to repost it. 

At the end of the day, people really want to know what is causing their symptoms and how to manage them. Whether you have definite MS or not, there will always be some degree of uncertainty; uncertainty regarding your risk of MS, uncertainty regarding the risk of future relapses, uncertainty regarding the risk of developing disability and uncertainty regarding your response to therapy, whether it be a drug, a dietary charge or a lifestyle change. How you and your physician manage these uncertainties together over time defines the art of the doctor-patient relationship.

If this process doesn’t work for you with your current doctor, discuss it openly with him or her and, if necessary, find a new doctor. Try to figure out what it is you require from a doctor to help you manage your chronic condition. As in the rest of life there will always be compromises you have to make but try to decide what you find to be most essential. Practical issues such as insurance coverage and distance from the doctor’s office are certainly important when it comes to narrowing down the list of doctors to consider, but should not be the basis of your decision.

To me a doctor must first take the time to listen and understand your narrative (doctors call this the “chief complaint”), ask probing questions, explain their interpretation of the information gathered to gain further feedback and information and then put together a plan of action that you are capable of understanding and that clearly addresses your initial complaints. This is much harder than it sounds since often the person describing the “complaint”, is not only unaware of the cause but also unaware of the influence of seemingly random or apparently unimportant aspects of their life on this complaint. 

To give an example, I am often asked by patients to help them with their daytime fatigue, probably the most common symptom of MS. Many patients simply assume they only need a medication for this complaint and have learned that other patients take various medications for their fatigue. In fact, the causes of fatigue are extremely difficult to unravel and require a skilled history and dedicated follow-up evaluations after testing, activity adjustments and possible medication intervention to arrive at a satisfactory solution. As with most problems in medicine this is an iterative process: First, the complaint is identified and understood as best as possible generating a hypothesis that involves further testing or an intervention; second, the patient is educated about the intervention and given the means to carry out the intervention and track the progress; third, the patient is re-evaluated to determine the initial outcome to the intervention and generate further hypotheses leading to further testing or interventions; etc.  This process requires skill, time, empathy and interactive resources.

Anyone with a chronic condition wants to find not only a good doctor but a doctor with the support staff and associated medical professionals dedicated to working together on finding individualized solutions to problems.

In subsequent blogs we will be discussing these issues at length. I will always begin with the importance of education. Simply knowing the facts, or what is not known, is sometimes all that is needed. Where there are choices to be made I will try to outline them clearly, although it may become clear that I have a bias to express. Remember, an unbiased interpretation of data does not exist. What is important is whether the interpretation of the data is consistent with the known facts and your belief system.