Max Laurens, MD, (left) and David Greer, MD stand in the new Neuroscience Center in the Yale Physicians Building.
(April 2011) Almost every neurological condition requires treatment by both a neurologist and a neurosurgeon at some point. If a patient suffers a stroke, a neurosurgeon may need to operate immediately to remove a blood clot, but a neurologist will closely supervise the patient’s care afterwards. A neurologist is typically the first specialist patients consult for epilepsy, but they sometimes require surgery to remove damaged portions of the brain if medications can’t control their condition.
Now Yale Medical Group patients are seeing both kinds of specialists in a new Neuroscience Center that opened in January on the garden level of the Yale Physicians Building in New Haven.
The Yale Physician's Building elevator opens directly onto the new center’s spacious reception area, where patients begin the consultation process. The new offices have 18 exam rooms, a large office for family conferences, and two rooms for procedures such as spinal taps. An electromyogram (EMG) lab, used to measure electrical activity in muscles, will be relocated to the center from Yale-New Haven Hospital to the new clinic this spring.
The setup makes it easy for doctors to work together to coordinate care, and for patients to see multiple specialists without having to visit different offices. “We’re interested in doing what’s best for the patient, which is to go back and forth between the two areas where specialties overlap,” says Dennis Spencer, MD, Yale Medical Group’s chief of neurosurgery.
Although the combined clinical space is new, the concept behind it is not. Yale Medical Group neurologists and neurosurgeons have always cared for patients together, and worked closely with colleagues who may include neuropsychologists and neuroradiologists and psychiatrists. During weekly epilepsy conferences, for example, treatment decisions are made as a team.
Dr. Laurens, right, examines a patient with David Greer, MD, by his side.
Yale Medical Group doctors specialize in many kinds of neurological disorders, providing unique skills and knowledge. For stroke patients, specialists provide aggressive treatment—such as snaking a catheter into the brain to evacuate a blood clot—that is not always available elsewhere.
Stroke experts in the practice are available 24/7 to two community hospitals by way of a video link-up that allows them to evaluate patients’ symptoms firsthand. “It’s important to provide round-the-clock coverage because people don’t have strokes only between 8 a.m. and 5 p.m. during the week,” says neurologist David Greer, MD.
Community doctors often collaborate with Yale Medical Group’s neurology experts to make a diagnosis. John Chapman, 81, was in bad shape when he arrived at Yale-New Haven Hospital by ambulance after Thanksgiving. Trouble with his balance quickly progressed to garbled speech, then to difficulty breathing that required inserting a breathing tube. At first, doctors at Waterbury Hospital thought he might have had a stroke, but when a CT scan was negative, they rushed Chapman to Yale-New Haven Hospital’s neurological intensive care unit, where Dr. Greer quickly diagnosed a brain infection in the cerebellum and began treatment. By the third day, Chapman was sitting up in bed, discussing a news article he had read with his son.
“Our priest had given him last rites, and my son and I were planning the funeral on the way to the hospital,” says his wife, Kathleen. “I couldn’t believe it when he recovered.”
Dr. Laurens, left, and Dr. Greer study images of the brain.
In the Neuroscience Center, doctors are providing sophisticated care for a range of illnesses and disorders. A Multiple Sclerosis Program integrates state-of-the-art MRI imaging techniques with the newest immunologic monitoring to come up with the best therapeutic treatments. Doctors working in the center have participated in pivotal clinical trials for many of the drugs currently used to treat MS.
Movement disorder specialists working with neurosurgeons can help ease the symptoms of Parkinson’s disease with deep brain stimulation, a surgical treatment in which an implanted device sends electrical impulses to specific parts of the brain.
Meanwhile, doctors expect the new center will facilitate all kinds of interactions between neurologists and neurosurgeons that could spark both patient care and research ideas. “If people bump into each other, things happen that might not otherwise happen,” said David Hafler, MD, MSc, chief of neurology. “So the idea was to create an environment where individuals interested in the nervous system would actually interact.”
“It all comes down to communication,” says Dr. Greer. “When you have good communication between the services, the patients always get better care.”
Story by Jill Max
Photos by Robert Lisak