Okay Cherie, I see this. The topic, as I wrote it, is far more than just the MC. It includes too much subjective stuff, but
not enough of it if it is going to be a thorough discussion. You feel (and I'm not sure I disagree) that the editorializing belongs elsewhere. I can try a rewrite with that in mind.
However you are mistaken about several things, and I finally see where your misgivings came from. You misunderstand what the Criteria are. They are not "about the MRIs". They build on the intent of the last 50 years in the progression of the Criteria. Before the two McDonald Criteria, there were the Schumacher and the Poser Criteria. They are all about the approach to the diagnosis of MS and, finally with the MCDonald Criteria, they "include" the way MRI data can be used
in addition to the other needed data.
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- that MS is mostly still a “clinical dx” (completely contrary to the “purpose” of the MC
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Cherie, you are completely wrong about the "purpose" of the Criteria. That sounds harsh and I don't mean it to be, but it is true. I have read a ton of the literature surrounding the development of the Criteria. I explain more below.
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However, what I did not expect to read, at least under the title “The McDonald Criteria”, were such topics as:
- an emphasis on the necessity for doctors to spend hoards of time with the patient, recording family history, doing in-depth neurological exams, etc. (at least from the get-go)
- the acknowledgement of a “clinical lesion” (particularly in a discussion about the MC)
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The reason I say you are mistaken is that I have researched the history of the development of the MC and they definitely DID intend to continue to state that the History and Exam is of
paramount importance. I have read the full papers accompanying the Criteria. The "purpose" of the McDonald Criteria
was to "reinforce the importance of clinical features, and to finally "include" the use of the MRI. They allowed the MRI to substitute for parts or all of a "clinical attack."
They base the
entire Criteria on the "Clinical Attacks and Lesions" that can be documented.
Only then do they tell the neurologist to look at the MRI data. So an intensive history and physical is
mandated by the McDonald Criteria in order to begin the process of diagnosis of MS. The only way to get this extensive Neuro history and Exam is to do it.
Finally, the definition of "an attack" in the McDonald Criteria - Revised - which is a technical
5-Page document, specifies that for the purposes of the Criteria, there must be a "clinical lesion" found on each attack reported by the patient.
Furthermore, The first column in the chart must be satisfied before you move on to the second column. This is the way medical charts function. So you must know "from the get-go" how many "attacks" and how many "clinical lesions" are present. Those two pieces of information can
only be obtained by an in depth history and exam.
Note:The consulting neurologist is going to bill from $350 to $600 for this initial service. By the laws of ethics and the legal laws overseeing medical fraud, a "Full Consultation" MUST include an in-depth H&P.
Those last 5 paragraphs
were not my opinion, nor my interpretation of the McDonald Criteria You or I might like them to be different, but they are what the formulators of the Criteria intended. I can't do anything about that. To ignore that or to downplay it would be to write something subjective and inaccurate.
But, I can cut out a lot of the editorializing. Keep in mind that I wrote this with the Limbo Lander in mind. I would have to redirect MY purpose in writing it. I certainly could have two discussions, very similar in content, but one with the emphasis where it needs to be for people whose evaluation consisted of 3 or 4 tests on the exam and a piddly history. Several members of another forum had a "full consultation" (as noted by the billing code) who were
never touched by the doctor! This is not only medical fraud, malpractice, but it is illegal and lousy medicine.
Before, we digress into another discussion of whether this often happens, I need to know that you see the point I am making about the necessity of a thorough H&P, and of the true importance (to the developers) of the "clinical lesion." Because, if you maintain that the "purpose" of the Criteria does not include those, we have no basis for discussion.
Why don't I try to boil down the article, remove the editorializing, and try to make it more succinct? It will still contain the information of the
intial importance of the history and exam. I am also going to post a thread with the article I wrote on the History of the Diagnosis of MS. That might give everyone a better background.
I WILL maintain my objectivity as this goes forward, I promise!
Quix