A century ago, the word “doctor” might have conjured up an image of a man with a doctor’s bag going from door to door to see his patients. Before the era of modern medicine, a doctor was expected to single-handedly deal with all the ills known to humanity. Lacking many of the modern amenities and drugs we take for granted today, a huge part of a doctor’s job back then was simply to offer symptomatic relief. 

Today, medicine has become highly specialized. A practical problem this causes is that the more specialized a doctor becomes, the less he or she is in touch with general medicine. In addition, doctors who belong to a particular specialty are answerable to their peers and their superiors in the same specialty; the unfortunate result is that cross-communication between disciplines can become diminished. 

Diseases such as multiple sclerosis require a unified therapeutic strategy, which is best conducted in a multidisciplinary setting. Medicine is always a forward-facing discipline, and all of us yearn for the day when most diseases have a cure. Meanwhile, we must make the most of the tools in our hands to extend survival and improve quality of life. 


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A Series of Moves 

In Therapeutic Advances in Chronic Disease, Inojosa and colleagues compared the therapeutic strategies of managing multiple sclerosis to a high-stakes game of chess. 

They argued that the best neurologists are, first of all, investigational and analytical, possessing an innate curiosity about their patients’ medical histories. In addition, neurologists need to be patient and organized, as well as intensely focused on the individual patient. Neurologists should also be committed to building empathic relationships with their patients. 

Read more about multiple sclerosis patient education 

“These characteristics are mostly shared with optimal chess players, who may overcome several scenarios in a game to achieve their objectives,” Inojosa and colleagues wrote. 

The devising of a suitable therapeutic strategy for patients with multiple sclerosis is likened to a series of chess moves. First, both physicians and chess players should determine the needs of their current position. They then need to look for a way to achieve their objectives, as well as find and compare feasible moves. The next step is to check for blunders before taking action, and then re-evaluating their new position based on the steps taken. 

What would be an optimal, achievable goal when it comes to multiple sclerosis care? Inojosa and colleagues argued that the stabilization or slowing of disease activity and progression represents a healthy therapeutic objective. If disease progression cannot be slowed down, the secondary objective of offering symptomatic relief for the improvement of the quality of life should be implemented. 

Like in a game of chess, time matters. The sooner treatment is started, the higher the likelihood of preventing further brain disease. Evidence suggests that the early diagnosis and treatment of multiple sclerosis can help prevent cognitive decline. 

“Furthermore, currently expected, achievable, and aspirational goals for prompt disease management have also been proposed as a result of an international expert consensus,” Inojosa et al wrote. 

The Multiple Sclerosis Care Unit 

Although neurologists play a heavy role in the treatment of patients with multiple sclerosis and are tasked to make a number of strategic therapeutic decisions, they do not work in isolation. The complexities of multiple sclerosis mean that a number of healthcare professionals are involved to ensure optimal care. 

“The entire spectrum of disease-modifying drugs should only be prescribed in centers where there is an adequate infrastructure to provide proper monitoring of patients, comprehensive assessment, and detection of side effects and ability to promptly address them,” Soelberg and colleagues wrote in the Multiple Sclerosis Journal. 

According to Soelberg and colleagues, the minimum requirements for a multidisciplinary multiple sclerosis care unit involve neurologists, occupational therapists, psychologists, physiotherapists, nurses, dietitians, speech therapists, social care workers, pain specialists, continence specialists, and spasticity specialists. 

Read more about multiple sclerosis treatment 

A group of professionals who rarely get the appreciation they deserve are social workers and counselors. They often act as mediators between patients and social or home care service personnel. They also help ensure that equipment such as walking aids, wheelchairs, and mini crossers get delivered to the patient. 

To borrow the analogy of multiple sclerosis therapy as a strategic game of chess, all of the healthcare professionals involved in helping patients lead happier, healthier lives can be likened to vital chess pieces that work synergistically to “checkmate” the disease to the best of current medical knowledge. 

The reality, however, is that a fully functioning multiple sclerosis care unit requires enormous amounts of funding, making it impractical in some areas. This is especially the case where multiple sclerosis is a less urgent medical priority (such as in Asia). 

However, there are good reasons for investing in multiple sclerosis care units that consist of healthcare professionals in different specialties. Having a fully operational multiple sclerosis care unit means we can have a better picture of what is clinically achievable now when we put our heads together. In addition, researchers can compare data obtained from various care units in order to draft the best treatment protocols for the future. 

References

Soelberg Sorensen P, Giovannoni G, Montalban X, Thalheim C, Zaratin P, Comi G. The multiple sclerosis care unitMult Scler. 2019;25(5):627-636. doi:10.1177/1352458518807082

Inojosa H, Proschmann U, Akgün K, Ziemssen T. The need for a strategic therapeutic approach: multiple sclerosis in checkTher Adv Chronic Dis. 2022;13:20406223211063032. doi:10.1177/20406223211063032