Improving outcomes in AL amyloidosis
Transcript: Multidisciplinary care for AL amyloidosis
Professor Stefano Perlini
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
So to sum up, a multidisciplinary team is very important, with different specialties involved, but the most important thing is that this team should work together, not only in the decision but also in the report and in the clear indication to the patient. The patient should be very aware that not several specialists, but a single team is taking care of her or him. Since Al Amyloidosis is a systemic disease, we really need to gather the expertise and the forces of different specialists in order to take the proper care of these patients. In my opinion, it's very important that in the centre of amyloid you can put together internal medicine doctors, haematologist, cardiologist, nephrologist, neurologist, for the clinical evaluation. Then you need to have a solid pathology department helping you in diagnosing and typing, and you should also have the possibility of having a genetic supervision in the cases in which you have to rule out other forms of the diagnosis, of other forms of amyloidosis. In a multidisciplinary approach, I do think that it's very important also for the patient to receive a unique comprehensive report on his situation.
Sometimes the patient are confused if they receive a paper from the haematologist, a paper from the cardiologist, another one from the nephrologist. It's much better if the team is gathering together, sharing the different aspect of the problems of the patient, discuss in a multidisciplinary way what is the best treatment option for the patient, and then to write together a final report and advice for therapy and follow up, in which it should be very clear that this a Al Amyloidosis cannot be tackled by a one man approach, it should be faced by a multidisciplinary team. Just to sum up, there are several expertise that are needed in amyloid: cardiology, internal medicine, haematology, nephrology, pathology, and genetic evaluation. They should work together, and working together is very important, on the one hand, to make the proper diagnostic and therapeutic approach for the patient, on the other hand, for the patient himself or herself, because he or she should be aware that the team is sharing this care.
We know that the multidisciplinary approach to diagnose and treat this disease, it's fundamental. One limitation might be the following: to have different professionals working together is not always easy, it's not always easy because sometime there are differences in the point of view or in the approach, so it's very important that the team works together. My advice is to sit once a week, all together, with the charts of every single patient in order to try to tune up what is the diagnostic approach and the therapy.
Obviously you need the expertise of many different professionals, but sharing is really fundamental. Another point that in my opinion is very important in the multidisciplinary team is that this team should be very open to any question from the patient or from the caregiver, or from the local doctor, in order to try to face them in the best proper way. In other words, I think that the multidisciplinary team that is from a centre of excellent should be give time, not only for diffusing the knowledge and the awareness of the disease in conferences and in congresses, but also in having a, let's say, a question time for the patients and from the doctors that locally are following up a single patient in order to try to gain the best possible angle to this patient, and to really share therapy. Sometimes the multidisciplinary approach has got a limitation in the application of the suggestions on the field, because maybe the patient is going back home, that can be far away from the excellence centre, and locally maybe something is not completely understood or not completely clear, or there are some info that were lacking. So a question time from the multidisciplinary team can help this a lot.
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