Hello, my name is Beth Faiman. I am a nurse practitioner at the Cleveland Clinic in Cleveland, Ohio. I'm fortunate to have been part of the myeloma care of patients since 1994, when I worked on the inpatient unit, and then, since 2000, in the outpatient unit. Since working in this specialty area for so many years, I recognize that patients with MGUS, monoclonal gammopathy of unknown significance, who may or may not have a myeloma or amyloidosis diagnosis, weren't always seeking specialty evaluation for their condition.
Now we have all these classifications—monoclonal gammopathy of clinical significance, renal significance, neurologic significance. So those patients, we felt, were getting missed.
So in 2014 I started a consult clinic. Nurse practitioners and physicians got together, decided to create algorithms for how to diagnose, monitor, and manage these patients. 1600 patients that we, as nurse practitioners who were specially trained, were able to see these patients. Now 1100 of them could stay with the nurse practitioner, didn't need to be referred to a specialist for care, which was good because it allows the physicians to have more time. But we also found a significant percentage of patients that had amyloidosis, multiple myeloma, and requiring treatment.
In summary, this is a positive study in that we are collaborating at my institution, and many other institutions can create this model so that patients with an abnormal protein can have specialty evaluations. So we could rule out other causes and appropriately monitor and manage their condition.
We actually have created a tumor board format. So let's say a community oncologist has a patient with an abnormal protein. And they're concerned about the workup. Does that patient need a bone marrow biopsy? Do they need better imaging to rule out myeloma? So we have a format where that community oncologist can refer to that tumor board or the advanced practitioner to have that conversation about what's best for the patient.
What's great about this clinic is we can collaborate with care as well. So sometimes we have a community oncologist that needs a little bit more direction. Maybe they have smoldering myeloma or maybe actual multiple myeloma. And then we can collaborate in their care, which allows for better care of the patient. They can stay in the community and stay with their community oncologists. They don't have to drive or pay for parking to that large institution.
So collaborating on care I think is super important and meeting the patient where they are. There's also another option for our clinic. It's called an E consult. So let's say that there's a physician or a nurse practitioner or a provider that is worried about whether or not their patient has a monoclonal gammopathy or a condition that needs to be further worked up. So they can place an order or contact us for an E consult.
So we'll review the chart, we'll review the clinical history and we'll provide recommendations to that referring provider. So we don't always have to inconvenience the patient or make them worried about their condition. But then we can help put their mind at ease. Sometimes it's as easy as saying, let's collect a little extra blood test. And otherwise it might be, let's bring them in for an evaluation and we could make sure we're not missing anything.
So again, that collaboration care is so important. And I have a PhD, but I'm a nurse practitioner. And I feel like that gap between the physician and the advanced practice provider and the patient, we can all work together as a team to provide the best care possible for that patient.
HealthTree • December 13, 2024