Brey, Robin L. M.D., Editor-in-Chief
The coordinated work of a team of professionals is required to provide the highest quality care to people with neurologic disorders. When you see a neurologist, the impact of her dedication, compassion, and experience may be easy to recognize. But many other people—some visible, others behind the scenes—are working hard to ensure you get the care you need.
Office staff make sure you provide the information needed by your insurance company so that you don't end up with a bigger bill. Without prior authorization for certain procedures or even office visits, insurance companies can deny payment. Insurance companies sometimes also require written justification for the use of certain medications or they will refuse to pay. Office staff provide that information as well.
In many offices, nurses and technicians see you before the neurologist to ask about your health; conduct parts of the physical examination, such as blood pressure measurements; and perform tests, such as an electrocardiogram (ECG) or electroencephalogram (EEG). These individuals are often available to answer your questions by phone or provide test results and medication refills.
In “The ABCs of Aphasia” (page 35), we discuss the importance of a team approach to aphasia, which often occurs as the result of stroke. In fact, a well-organized team is necessary every step of the way for stroke patients. Stroke is an emergency: If a person can be evaluated within four-and-a-half hours after the stroke begins, it may be possible to give intravenous clot-busting medicine (tPA) that can lead to better recovery. The first and most important step is recognizing the signs and symptoms of stroke:
* facial droop or uneven smile
* sudden weakness or numbness of the arm or leg
* slurred speech
* sudden severe headache
* sudden confusion, trouble speaking or understanding
* sudden decrease in vision or dizziness, loss of balance, or lack of coordination
If any of these things happen, call 911 or go to the closest hospital. If you call 911, the emergency medical system in your area begins the evaluation and treatment process. At the hospital, the emergency room staff assess the patient quickly and conduct lab tests and brain x-rays to diagnose the cause of the patient's symptoms. This requires laboratory and radiology professionals to be available any time, day or night. A stroke expert must be called immediately to help decide if tPA is safe and likely to help. If tPA is given, the patient will be monitored by nursing staff at least hourly for the first 24 hours. Speech therapists help evaluate whether the patient can safely swallow food or medications. Rehabilitation specialists help determine the best program for recovery. Without this team working together seamlessly, high-quality acute stroke care would be impossible.
A team approach is needed for many neurologic disorders. For example, neurologists work with neurosurgeons, radiologists, and neuropsychologists to evaluate and treat patients with epilepsy when epilepsy surgery may be the best treatment option. Neurologists also work with rehabilitation specialists, speech therapists, and pulmonary medicine specialists to provide care for patients with amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease).
Of course, the most important team members are you and your loved ones. In the case of stroke, you are the people who take the first, most important step: getting to a hospital or calling 911.
Tell us your experiences with a health care team—including the role you played. Also, send us your suggestions about how health care teams can work together better.
Take good care,
Robin L. Brey, M.D.