During the first two years of his treatment, Dr. J. Steven Gaines formulated several messages for doctors treating patients not only with MG, but with any chronic disease:

1. Be more aware of MG and its symptoms. Those patients with eye-related symptoms are easier to diagnose, but doctors need to be on the lookout for those with chronic fatigue-like symptoms. Some patients have suffered through years of illness without a correct diagnosis .

2. Be aware of a family history of neurological disorders. This might be a tip-off that a patient has MG.

3. Treat each patient with respect and give your complete attention to the patient during their appointments. It means everything to them.

4. Don’t give up on a patient if they seek an additional opinion. Check your ego at the door.

5. Listen to what your patients tell you. You can learn things about their diseases that is not “book-learning.” This will help you provide better treatment.

Setting Up a Quality Program of Palliative Care

Dr. Ron Henderson feels strongly about how physicians should formulate care for chronically ill patients.

1. The palliative care program for the chronic patient should use a team approach. It should be led by a primary care physician and then supported by specialty physicians. Never forget that the patient and the patient’s primary caregiver are important members of this team.

2. Make sure all the needed physician resources have been called in to address the patient’s multi-problems. A chronic disease patient needs a wide range of medical support. S/he may have several specialists for varied needs, but there must always be a primary physician.

3. Make sure that all the needed non-physician healthcare issues are addressed with the patient or caregiver – issues such as at-home care, support for the family and counseling services. Nothing should fall between the cracks. The primary doctor should serve as a traffic cop among all the patient’s doctors and make sure social issues and at-home care issues are addressed.

4. Know about and work closely with resources in the community that can help the chronically ill patient. The doctor should be able to tell the patient or caregiver about community resources that can help with issues such as spiritual counseling, psychological counseling, home-healthcare and financial assistance.

In addition to the above care areas, Dr. Henderson suggests other approaches aimed at both the primary physician and the other physicians on the patient’s team.

1. Look at the patient as your friend first and as your patient second. Treat this patient as you would treat a member of your family. Ask yourself if you would recommend treatments for your own loved ones. Use a caring manner, eye contact, smile and ask questions that show concern.

2. Listen to your patient. If you listen very carefully to your patients, more often than not they will tell you what’s wrong with them. Indeed, a patient can help you with the diagnosis.

3. Let the patient know that you’re interested in him and his healthcare. Stay in touch with the patients – phone calls in-between visits – let the patients know that you care. This will let the patient know that he is on your “radar screen.”

4. Be honest with your patients and their caregivers by walking that fine line balance of accuracy, reality and hope. Paint as positive a picture as you can. Trust in one’s physician is essential and most people can more easily accept devastating news if it is delivered in an honest, straightforward manner.

5. Fully and willingly accept your role of responsibility in caring for this chronically ill patient, without viewing it as a burden. Look at the situation from the patient’s point of view. They have to deal with the ravages of the disease and any side effects from treatments. They need a long-term commitment from their physician over a long period of time.

6. Individualize the treatment plan for every single chronic disease patient. Patients should be treated individually, not with a cookie cutter approach. Avoid going overboard in standard templates. The “one size fits all” approach doesn’t work well for the chronically ill patient. Just as no snowflakes are the same, then no cases of autoimmune diseases are the same.

7. Stay current with the scientific literature. Stay abreast of the latest developments in your area of expertise. We are in an era of explosive knowledge. You owe it to your patients and to yourself to stay up to date.