One of the things we looked at when we were trying to develop the guidelines was that, as I mentioned, some other countries have guidelines, and one of the real difficulties we have in Parkinson's, when it comes to evidence-based medicine, is how much evidence-based medicine we have for treating the depression, for treating the bladder troubles or bowel troubles, or all the other things—these non-motor things that you're starting to hear about with Parkinson's.
The answer is that there's not much evidence-based medicine. If you look at the American Academy of Neurology guidelines—they just came out this year—for treating these non-motor things, they have six or eight different, huge topics in Parkinson's. They came out with three recommendations that were terrible.
So we have to step back and say, if there's not evidence-based medicine, we still need to treat people, we still need to diagnose people; how can we come up with the best way to do that in Canada? That's what we tried to do in the guidelines.
There's still a clear need for better research into coming up with better ways to diagnose people with Parkinson's. We still need to do a better job at it, because people have to rely on coming into my office and my telling them yes, you have Parkinson's, and no, there's no test that can confirm that this is what you have.
The people we see are very complicated and have many different issues, and I am definitely not an expert at treating a lot of those things—the balance issues, and which cane is the best, which walker is best, different things to help you get up out of bed, what the best exercise is for this individual when they have a bad hip as well as their Parkinson's, or a bad knee. These are all things that I'm certainly not an expert in.
This is where the multi-disciplinary team comes in. Do I call any patient that night after I have diagnosed them with Parkinson's? The answer is no, there's no time. Would it be nice to be able to do that? Yes. We are fortunate enough to have two nurses in our clinic who answer the phone and try to give out advice on the phone, but it's not easy. It's frustrating for people even when I see them in the clinic. I try to see them a month after I give them the diagnosis, and that's rather squeezing them in, because I don't have any appointments for six months.
There's no question that we need to do a better job as a team of treating this very complicated condition.