Just as no two patients are alike, neither are their visits with us. Each visit may deal with a different aspect of a problem and conditions can change over time. We individualize our visits to the needs of the patient and we try to stay on schedule as much as possible.

The two main types of visit are the first assessment and the return visit. The first assessment may take up to a couple of hours, including the different evaluations and the patient teaching session at the end of the visit, when appropriate. The return visit is a more compact encounter, usually lasting about twenty minutes to a half-hour.

The First Assessment

A typical first visit deals with the patient's general health and how it is affected by their neurological problem. In general, the patient is first interviewed by the RN to gather the large amount of information needed for the general health profile as well as a very detailed discussion that characterizes the symptoms and how they impact on the patient's life. Next, the patient sees the neurologist who reviews and revises the intake information and continues the discussion of the patient's problem. He will review all available medical records, patient diaries, tests, etc. and perform a detailed neurological examination. He will discuss the diagnosis with the patient and significant other and make treatment recommendations. The treatment plan is then explained to the patient in a personalized teaching session with the clinical nurse. A note describing the findings and treatment plan is then sent to the patient's referring physician if desired.

The receptionist can call for missing records or test results. The nurse looks through the patient's medication list or pharmacy printout or look at each medication bottle the patient has brought in and enter the medication and doses into the computer. Past medical history is pieced together from records brought by the patient and all pertinent test data is entered into the database. The nurse then reviews and corrects all this information in the context of the patient's problem. The neurologist then reviews the assessment and launches into detailed questions and clarifications of the information in the computer. The physician reviews all x-ray films and additional data and performs a detailed neurological examination. Findings are entered into the computer and we discuss assessment with the patient. All of this information becomes part of the electronic medical record.

The completed consultation is faxed to the other physicians designated by the patient and the prescriptions and test requests are printed out. A multiple page instruction sheet is automatically printed out and used in the patient teaching phase of the visit. This is the plan for the patient to follow until the next visit.

The Return Visit

When a patient returns to the clinic, the nurse will obtain information describing any problems that arose since the last encounter and ask detailed questions about the symptoms, toleration and effectiveness of the treatment and any pertinent health issues that may have developed. The neurologist then will review test results, reexamine when appropriate and make changes in the treatment plan. The Nurse Practitioners will similarly evaluate and manage the patients within our practice parameters.

We ask our patients to describe their progress, experience with our medications and how often each medication is used. We need to know about any other health problems that may have come up in the meantime. Please bring the names of any new medications or the actual bottles if new medications have been prescribed by your other physicians since the last visit.

We will then review your response and make further adjustments to the treatment plan. Remember, it sometimes takes a few tries to get a medication that is effective and well tolerated, so please be patient with us during this process. At the end of the encounter, we will again generate a detailed written plan and the nurse will go over it with you.

After all encounters, the patient is given typed instructions with medication information, test descriptions, etc. A registered nurse is available during office hours to handle all patient phone calls, and all these are discussed with the neurologist and communicated back to the patient.

Our office visits are sometimes very much like a meeting. Certainly, we examine the patient when appropriate and write prescriptions but our visits are more than that. They are often a meeting between the patient and family members, the nurse practitioner or the RN and the neurologist. We believe that the treatment recommendations need to be acceptable to all parties or the plan will not be successful, so we discuss it on a regular basis during scheduled visits.