Jeffrey Dunn, MD: Dr Berkovich, thank you so much for the detailed answers on these specific questions. This program is about trying to help our colleagues in the best care of patients with MS [multiple sclerosis]. In a global way, what resources are available for health care providers to assist with a patient population? And I ask that as an open-ended question.

Regina Berkovich, MD, PhD: Thank you. And thank you for all the previous questions. It was a very interesting discussion that we had. I would like to underscore again that I was expressing my own opinion, and people may agree or disagree with me, which is absolutely expected. My view is that the No. 1 tool that our colleagues, general neurologists, do have, but may underutilize, is us as MS specialists.

Jeffrey Dunn, MD: How do you mean?

Regina Berkovich, MD, PhD: Sometimes we see patients being referred to us for consultation in respect to disease-modifying therapy when it might be too late, and it’s never too late, admittedly. We always can make some better choices, and we do, but I wish sometimes that the patient would have come to me 2 years earlier, or soon after the diagnosis, or soon after the activity on MRI, or relapse. [This would be the point] when a decision on going with a disease-modifying therapy of certain mechanisms could have been explained to the patient, and the risks could be reviewed without emotional drama involved in it, so that we could have navigated the treatment better. I would like to say that in addition to all the publications that you find with the CMSC [Consortium of Multiple Sclerosis Centers], ACTRIMS [Americas Committee for Treatment and Research in Multiple Sclerosis], National MS Society, MSAA [Multiple Sclerosis Association of America], and Neurology Today, all of those are important. But don’t forget that you have MS experts in every city, and we would be happy to provide those consultations because it would be better for the patient to have a timely consultation and review different treatment strategies when it would be more impactful, which is earlier in the disease.

Jeffrey Dunn, MD: Great advice. There are multiple resources, it seems, that can help provide education, and empowerment tools. Are there ones out there that you find yourself turning to or advising your patients to look to, in addition to the advice you can give them that you might share with our audience?

Regina Berkovich, MD, PhD: I would like to continue building on what I said, just now. Like my colleagues, general neurologists rely on me in the same way I rely on them.

Jeffrey Dunn, MD: Who’s them?

Regina Berkovich, MD, PhD: General neurologists, my colleagues who refer patients to me. I wouldn’t be able to treat every single patient without the help of general neurologists who are there, locally, closer to a patient’s home, who will help with everyday needs, with symptomatic management, with the refills of the medications, etc. We should work more in the sense of us MS specialists doing less of the routine care, such as treatment of UTIs [urinary tract infections] and refill of the medications, but doing more in terms of the consultations. I have this approach that I’m continuously sharing my patients with the referring neurologist. I always reiterate to my patients, don’t sever your connections with your general neurologist who referred you. A, because that would be sending a wrong message, and we may never get a referral again. But importantly B, is because you may get better routine care there, and better specialized care here. If that ends up with a patient seeing more frequently the general neurologist who is local, close to home, and then seeing me after the MRI, for example, or every time a disease therapy decision needs to be made, that is the best scenario. That has worked well for my practice for years.

Jeffrey Dunn, MD: There’s a movement in academic circles now to rename general neurologists as comprehensive neurologists, which is more flattering and really speaks to how active they are in all aspects of management, and that they need to know all of the subspecialties with a great degree of operative knowledge.

Regina Berkovich, MD, PhD: Let us help, but let us share patients and not to take over those patients entirely. That’s my philosophy, that’s my view. And I can tell you, it’s been working well.

Transcript Edited for Clarity