LUCY SCHULTZE

TAMPA — As president of the American Academy of Neurology (AAN), Dr. Stephen Sergay leads the world’s largest group of neurologists at 20,000 members strong. But when he’s in his clinic in Tampa, Fla., there’s only one individual on his mind — the patient sitting in front of him.

The person-centered relationship between patient and physician is one Sergay hopes to see return to the forefront, in an age when efficiency and cost savings can go only so far in reforming America’s healthcare system.

In Washington, the AAN is advocating a broad range of policy positions, from reimbursement issues and research funding, to how America can best care for Iraq War veterans with traumatic brain injuries. The academy has also maintained support for embryonic stem-cell research within strict federal guidelines, since issuing a position in 2004 alongside the American Neurological Association.

In private practice, Sergay is part of Tampa Neurological Associates. He is also a principal founder of Axiom Clinical Research of Florida, where he conducts clinical trials for major pharmaceutical companies.

Sergay holds a medical degree from the University of Witwatersrand Medical School in Johannesburg, South Africa. He completed his residency at the Harvard Longwood Program in Boston, where he served as a neurologist at the Lahey Clinic. He was an instructor in neurology at Harvard Medical School for four years before arriving in Tampa in 1980.

What has been your academy’s focus on the issue of traumatic brain injury?
We know there will be a lot of people returning from Iraq who have been wounded by an improvised explosive device (IED). When someone has a wound from shrapnel, it’s easy to recognize. But some troops in vehicles that have been under these high-impact attacks might have sustained a head injury without knowing it. They don’t have a fractured skull and they’re not bleeding, but the brain may not be functioning properly.

Its consequence might be emotional or intellectual impairment or even epilepsy, but that may only occur years after the injury. So we have been working a lot with the federal government to try to ensure the capability of analyzing troops before they’re submitted to these kinds of injuries and also afterward, to see if there is a difference. We have also tried to work towards increasing the capabilities of the VA for traumatic brain injury care and rehabilitation.

In neurological research, what new advances do you foresee in the coming years?
Neuroscience has never been more exciting. It’s the day-by-day unfolding of new information that keeps us all glued to our chairs. We just don’t know what’s going to happen next.

The Human Genome Project has been a substantial opportunity. In the past, we often classified diseases as to how they occurred in certain families, not understanding the basic chemistry and physiology. But since the project, they will now be classified by what chemical is missing or incompletely functional. Once that is known, the meaningful search for treatment can begin.

In addition, behavior disorders have been difficult to understand on a brain basis. In the past we used accidents of nature, such as a stroke resulting in a loss of language capability, to understand the part of the brain required for language use. But we’re now understanding more and more about behavior and the brain on a basic cellular functional level, opening the way for us to begin to understand impairment on a chemical, anatomical and functional level. The day is not far off when treatment will be radically different, and I believe this will still require cognitive specialists and psychologists, but will also use medicines derived from our new understanding of this information.

In what ways does the brain remain the body’s biggest mystery?
The brain will always be in part a mystery, I believe. It’s exciting to me that every time we find out one thing we didn’t know before, it opens the door to another thing we don’t know and thought we didn’t have to worry about — and all of a sudden, it’s the next step we need to take. Those steps seem to me to be ascending into infinity.

We know an awful lot about the brain, but we’ve got a long way to go. I often think of it like, the brain can look down at the hand and understand it, but we have nothing that can look down at the brain and explain it to us, but for our own brain.

What effect do our lifestyles today have on brain health?
I think lots of things out there are good. For example, our efforts to reduce risk factors for vascular disease, such as weight, blood pressure and cholesterol, have proven very beneficial in reducing the risk of stroke and probably dementia. I also think we are more cautious now in letting people go back into a sporting arena after a concussion, and we’re still working to reduce the risk of head injuries in sports and in the military.

We’ve come to understand, that old saying, “If you don’t use it, you lose it,” is also true for intellectual exercise. For people who are more intellectually active, the risk of developing dementia is reduced. Many things are helpful, but we haven’t even begun, really, to profit from all the opportunities our new technological capabilities will bring.

What are your hopes for our broader healthcare system?
I have always believed there is nothing more important than actually listening to what people have to say. In becoming a more technology-based society and with the efforts our government has made to control costs, the quality of that encounter is threatened.

I believe that in our healthcare system we’ve looked at efficiency, which is important. But I believe quality is also a big issue. It’s not just about the tests we do, but the opportunity for people to talk to their doctors and for doctors to talk to people.

How can the right decisions be made in the absence of hearing about a person’s complaints, and how can patients manage their care on returning home, if they are not provided with the opportunity to understand what is expected of them?



April 2008