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Caring for people with Parkinson disease (PD) in the traditional office setting, by an individual clinician, is challenging. It is often not easy to get an appointment. One of our patients joked that he considered posting his appointment on eBay. Further, the amount of information that should be covered in the usual 30-minute follow-up visit is daunting: an assessment of motor symptoms and their impact on activities of daily living, including motor fluctuations or falls; a medication review; and screening for nonmotor symptoms of PD including cognition, autonomic dysfunction, sleep problems, depression, anxiety, hallucinations, and delusions.1,2 Additionally, a review of any new general health problems and an assessment of the caregiver's status is needed.
Once all of this is covered, then one proceeds to an examination, ideally including a test of mental status. The visit concludes with the physician's assessment of the information gathered and management recommendations that often include medication adjustments. Inevitably, and appropriately, patients and caregivers have questions; prescriptions have to be written (“for 3 months but also one for 1 week for the local pharmacy as I'm about out”); and then a note must be dictated.
This is not possible to accomplish in a half-hour appointment. Practically, one compromises thoroughness of patient care for expediency. Additional resources for patient care include nurses and other physician extenders, support groups, written literature …
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