Ruth Ann Marrie, MD, PhD: Collaborative Care and Comorbid MS Patients

Ruth Ann Marrie, MD,PhD, FRCP, associate professor of medicine and health sciences at the University of Manitoba: Well, I’m lucky enough to work in a team. There are several sub-specially trained physicians [who work] with multiple sclerosis, who are supported by nurses who are highly knowledgable about MS (and who do lots of education and patient support), and then we have occupational therapists, physical therapists, a dietician, and a social worker who form part of our immediate team that can support patients. Then we consult other specialists as needed.

So in that allied health team, we’re quite collaborative. We’re lucky to have an electronic medical record where we can communicate with each other and see what everybody else is doing at the same time. And that’s been really helpful in terms of [not only] trying to get people what they need but making sure that the best person who has the greatest skills is working on a particular issue. If a couple of team members say, “We need to have a conversation,” or, “We need to see this person together to optimize their care,” then we can do that.

I think the first thing is recognizing that comorbidities are common in the individuals that we treat and so we should be asking about them, and be making sure that they’re at least treated to the standard of care so that [the situation] is not, “Well you, have MS, you have enough problems, so I’m not going to worry about your diabetes or your high blood pressure.” Those things need to be treated in their own right, and we now know that those things can also affect MS outcomes.

We can take, even, a step further back, to be more proactive - which is to say, “What can we do to prevent these comorbidities from arising in the first place and causing trouble?” And what is that? Those are things like heart-healthy diets, helping people finding a way to be active despite their MS symptoms, helping them to achieve a healthy weight, giving people support to quit smoking. Not just saying, “You should quit smoking,” but actually providing them with the support in order to do that.

That could both help the MS and help prevent comorbidities from occurring in the first place, and then we don’t even have the problem of dealing with them.