The Multi-Disciplinary Team

Over a fairly lengthy period of time I tried treating seriously NeuroPsychoSocially Disordered and/or addiction patients on my own, but I couldn't make it work. I couldn't give them the amount of time and attention needed to give satisfactory results, when they turned up without appointments; I couldn't afford the amount of time lost if we made appointments for them, as these patients are so often incapable of keeping appointments; and many seriously NeuroPsychoSocially disturbed and/or drug dependent patients didn't make it back for another try for weeks or months, if they were not helped significantly, on the first day that they presented.

Also my personality, expertise and approach were helpful for most of the patients at some stages of their diagnosis and treatment, but not at some other stages of treatment, and not for some patients. We needed to have several different personalities, with different expertise and strengths, to meet different aspects of different patients' needs. We also needed somehow to be able to take advantage of the fact that it was so much more effective for these patients to be diagnosed and to have their treatment commenced when they were ready and motivated, and had found their way to our Centre, even if they had to wait for an hour or two, which this type of patient is usually very used to doing.

To enable prompt adequate attention to be given, without unsustainable loss of my time, we decided that the initial work with new patients had to be done by capable but more junior, lower cost healthcarers, who we could afford to keep relatively available, for whenever new patients came in. But for those more junior healthcarers to be effective, we had to provide them with Instruments and Protocols that had a multiplier effect with regard to their capabilities, to compensate for their lower levels of training/experience. (Although not as qualified, these junior healthcarers are very intelligent, capable young people, who I regard as my intellectual peers).

The first Instrument we developed, to empower our junior healthcarers, was the Mini Checklist. An on the ball Bachelor level healthcarer can use this computerised checklist, to get a new patient to answer 127 very carefully chosen and structured questions, in approximately fifteen to twenty minutes. Fifteen to twenty minutes is usually the optimum period for this type of patient to maintain their concentration and to continue to give accurate answers, and for us to get most of the information that we need from them. The computer then processes the answers and prints out the probable diagnoses, rated and ranked in significance, within 1 or 2 minutes.

The second tool we introduced to enable junior healthcarers to do very effective front-end work, was the Brain Electricity Assessment. Using specialised ElectroEncephalograph (EEG) software, Bachelor level healthcarers who have received 3 or 4 months of in-service training, are able to do very helpful diagnostic EEG's (Brain Electricity Assessments) in 15 to 20 minutes. These Brain Electricity Assessments help to confirm or to rule out the presence of Disorders, where there is some doubt after the Mini Checklist has been done. These BEA's also help to clarify the relative severity and significance of the various disorders present in complicated cases. Even with the Checklist and a Clinical Assessment it may still be difficult to decide whether a patient's distress and dysfunction is more due to their anxiety and depression, or more due to their insomnia and fatigue, and the BEA helps to make these decisions. The Mini Checklist may reveal that a patient has both ADD and Manic Depressive (Bipolar) Disorder, but it may be difficult to assess the relative importance of these 2 disorders, which require different medications. The BEA helps to clarify the grey areas and facilitate decisions re pharmacotherapy and counselling.

With 2 receptionist/secretaries, 1 doctor, 1 senior counsellor, and 4 multiskilled Bachelor level Clinical Assistants, one of whom is also a very capable tech. support and 2 of whom are trained to do EEG work, we find that someone from our staff can almost always commence accurate assessment of new unbooked patients, within 15 to 45 minutes of their arrival. The senior counsellor or any of the 4 clinical assistants firstly do the Mini Checklist. If possible, one of the two EEG trained clinical assistants then does the Brain Electricity Assessment.

Depending on how busy the clinic is at the time, I then spend somewhere between 10 and 30 minutes going through the Mini Checklist results and the Brain Electricity Assessment with the patient, assessing them clinically at the same time. I then prescribe accurately targeted pharmacotherapy, using the fast, easy, touch screen medication menu and computerised prescribing facility, which we have developed.

We find that for the diagnostic work needed, and the Triple Therapy that we recommend in almost every case - 1. Pharmacotherapy, 2. Counselling and 3. NeuroTuning (EEG Biofeedback) - and the range of temperaments needed to work with the different patients at different stages, our 8 person Chemical Health Centre team is ideal, and does prompt, very strategic, powerful, highly effective work, in a very cost effective way.

At The Family Neuro Health Centre, where we don't treat people with addiction problems, and less patients have a large number of severe NeuroPsychoSocial Problems, we mostly work by appointment, but are often able to do diagnostic work which would normally take 30 to 40 minutes, with a patient who only has a 15 minute appointment. (Even at the Family Neuro Health Centre, because they quite often miss appointments, we usually only set aside 15 minutes for new patients). This enables accurately targeted and significant treatment to be started at the conclusion of the first consultation, which gives the patients rapid relief, and encourages them and motivates them to continue. Also we are able to do the Mini Checklists, the Brain Electricity Assessments and the NeuroTuning (EEG Biofeedback) Sessions for $40 ($30 concessional) each, which appears to be extremely good value for money, in comparison to other methods of dealing with these health problems.