Myasthenia Gravis Learning Zone
Transcript: MG questions clinicians should ask
John Vissing, MD, DMSci
Interview recorded March 2026. 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.
Hello everyone. My name is Sir John Vissing. I am a neuromuscular specialist based in Copenhagen at the National Hospital.
Today we will talk briefly about what MG patients never ask in the consultation and what we as clinicians perhaps should ask the patients. Of course, this is clearly my opinion. So usually what I do when I see the patient the first time is to chat a little bit with the patient. You know, maybe talk about their vacation or such things, just to create a personal alliance with the patients if you don't already have it, if you follow the patient for a long time. And then after this, move to asking the patient, what is really the most important question or problem that you want to talk about today? Open this, if the patient hasn't started this conversation by themselves, if they don't, I mean, you can start asking about what problems that they have. Do they need to take breaks during the day? What the routines are they doing that take longer time? And do they have specific physical symptoms such as we see here on the right side in green chewing, head control, stair climbing and so on.
If it is not really clear what the patient tells you here, they maybe have problems expressing what their problem really is, I usually move on to ask them another kind of open question, and this is the patient acceptable symptom state or the past question, which just reach like this, if you had to stay in your current state for the next months, would you say that you are satisfied with your current disease state? And the patient can then answer yes or no. And typically what we see is that 1/3 of patients are not happy. And then this could prompt you to go on to ask a little bit more, also to examine the patient using some of these functional tests as we see here, or fatigue test as we see here on the right side in green. And then apply the myasthenia gravis specific disease severity scales.
The MG ADL and the QMG. QMG is usually takes some long time, so you would need extra time for this. Maybe your physio can help out but also probe into depression. So this is the major depression inventory that you could pose to the patient, like 20% of patients do have depression and maybe have a hard time telling you. So you have to examine this, and the same with fatigue. Either the fatigue severity scale or the multidimensional fatigue inventory as we see here, which can then lead on to something you can actually do for the patient. The other thing you need to talk to the patient about is a shared decision making on treatment expectations.
There are many things to consider. Obviously we all aim for a complete remission and I think physicians and patients align on this, but sometimes this is not achievable. What should you achieve then? What is the most bothersome symptom you should ask the patient that you have? Is it diplopia or is it that you have swallowing problems or something different? Ask the patient, what is it they want to have relieved by the treatment. Other things in the treatment that you need to accept and agree on is what side effects does the treatment actually give you? One thing is effect, but the other thing is there's sometimes a trade off, also on side effects.
So this is really some of the key questions to ask the patients that they may sometimes not ask themselves. Thank you for your attention.
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