Pavel Klein, MD: Initiating Conversations on Changing Treatment Strategy


The director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland, described the challenges he’s faced when having to discuss a change in treatment strategies with his patients.

"It’s a terrible conversation to have. A person like that is caught between the devil and the deep blue sea.”

If a patient does not seem to be responding well to a treatment regimen, they may be looking to switch treatment strategies, whether that corresponds to a new treatment or changing doses, is decided through conversation with their clinical care provider. Changing treatment strategies can be a delicate discussion, and oftentimes clinicians must explain the realities of adverse effects and the harsh truth that a new regimen is not guaranteed to succeed.

These obstacles in switching to a new regimen have been exacerbated throughout the COVID-19 pandemic, mainly from the lack of in-person visits, which can hinder a clinician’s evaluation of their patient. There can often be discrepancies between the patient and the caregiver on where their treatment strategies should turn to next, which can add another wrinkle in the transition process, according to Pavel Klein, MD.

Klein, director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland, has been a part of a fair share of difficult conversations regarding changing treatment strategies. In an interview with NeurologyLive, he details a discussion he had with a patient and their caregiver as an example of the some of the challenges faced when coming to a conclusion on the most optimal regimen.

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