Quote:
Originally Posted by Quixotic1
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.
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.
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
|
I understand your points, QUIX, and appreciate that my explanation of what I "expected" would come across as extremely black and white (with no consideration to the history of MS dx, etc.).
I was really just trying to back up the discussion to try to make my underlying point clearer; that what I'd like to have seen, is this more from the perspective of a suddenly sickly person (vs. the frustrated person who's been put through the wringer with their doctor already . . . WAY over-dramatizing that point too, but I hope you know what I mean).
There are so many ways that people can present with MS, but one thing I know for sure . . . doctors seem to HATE when patients come in and think they've got it all figured out already.
I'm sure that doesn't happen very often, but it does happen. I suspect the "traditional" way people present is just plain scared, with very seldom the thought of MS (isn't that the Jerry disease?) on their mind.
In my case, for instance, I thought I was a perfectly healthy person until I became paralyzed over a week or so. In retrospect, I had had symptoms of MS for years already, but never connected them to that incident until YEARS after the dx . . . And, even though MS is very prevalent here, THEY did not appear to approach what was happening to me from an MS-angle at all either . . . well, at least I had no idea that they were.
They did X-rays of my spine (I lived in a ski village), they asked about recent viruses I might have had, they tested my "numbness" with pins . . . all the usual stuff for "spinal injuries" and mennigitis-type stuff.
Eventually I landed in the city emergency, and was admitted for a series of tests, including an LP/Myelogram, some visual thing . . . lots of poking and prodding. Since they botched the LP in a very bad way, that left me in the Brain Trauma Unit, completely K-O’d for a further week. By the time they got around to even suggesting a MRI . . . I BOLTED (well limped terribly bad)!!
When I saw the neurologist a week or so later, she mentioned transverse myelitis and the likihood of MS or a virus that got into my CNS. Her final words were "time will tell". It was 12 yrs before "time told" . . . and it didn't happen to matter to me because there were no drug options available or recommended anyway.
My point is only that things do not usually fit into a nice, neat little package . . . as we all know that
. However, I think no matter how we present (paralyzed, blind, or weak), and depending on how serious our current condition is, (perhaps combined with a detailed history, if we can talk) . . . they put us through a series of objective tests to see if it MAY be something else (first), or MS (last). If it comes down to leaning towards MS, at a minimum, we should have all the testing associated to the MC.
I realize you approached this from a limboland perspective, and that’s what didn’t feel right. I just feel the MC section is what it is (whatever it is), and nothing more.
Anyway, I think that's all I have to say about this (for now anyway). Everything I've said has been over-dramatic, without consideration for the history of MS (I know, they used to just put us in hot water, then called it "hysteria" when they figured out what was wrong
). I'm just suggesting to keep this MC summary simple and concise, like you have with everything else.
Cherie
__________________
I am not a Neurologist, Physician, Nurse, or Hairdresser ... but I have learned that it is not such a great idea to give oneself a haircut after three margaritas
.