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Will Telemedicine Change Practice For Neurologists?

Discussion in 'Neurology' started by Mahmoud Abudeif, Jul 2, 2019.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    Teleneurology is one branch of the expanding field of telemedicine. In this exclusive MedPage Today video from the recent American Academy of Neurology's annual meeting in Philadelphia, Marisa McGinley, DO, of the Cleveland Clinic, discusses the technology's advantages and limitations for neurologists.
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    Following is a transcript of her remarks:

    I think that teleneurology is not going to be the right fit for every single encounter with a patient, and it's also kind of [based on] us, as a field, learning about where it can be additive and not subtractive. Admittedly, there's a lot to figure out in that respect. Right now, obviously, what we presented here at the AAN was all follow-up patients in an academic center. But I think that although the exam is very important in neurology, a lot of what we do in the subsequent visits is symptom management and also discussing logistics of medication use, new things that are happening, also chronic-type conditions. Really, the meat of the experience with me for patients, even in the office, is that discussion.

    As a neurology trainee, one of the things I was always taught is let the patient talk for as long as they need to and they'll tell you what's going on with them, and you can get to your diagnosis even from that. So taking a good history, even initially, it's a lot more about that conversation and listening to the patient. I think that teleneurology sometimes allows us to focus back on that and just really what the patient is experiencing, and we're not getting into this, "I have to talk to them about these two things, then I have to do these parts of my exam to document for my note to get paid." I mean there's a lot of box checking that happens, especially in subsequent visits. I think teleneurology, for me in my practice, really allows me to just sit there and just talk to the patient about what's meaningful to them.

    With that being said, I think that the exam is obviously still hugely important, especially when patients are having new symptoms. It may be that teleneurology is not always the right thing, especially if someone has really nuanced weakness that I need to evaluate in my clinic. I'm not going to always say that's the most appropriate approach. I also think there's going to be ways that we're going to learn to supplement our teleneurology visits. Right now, it is just a conversation and people find creative ways to have patients walk in their home and we can still visualize them in that environment, which, in a way, is something we can't do in the office in that natural home environment. We can actually get some more cues and interesting things about how they're maneuvering.

    I think we also have to shift what we think the exam is. There's the hands-on component, but there's also a lot of visual inspection that can still happen with teleneurology. I also think there'll be ways to use consumer devices or in-home technology at some point to kind of supplement in-home neuroperformance that can then augment, again, that physical exam aspect that we're not necessarily getting currently. I mean I definitely agree with the skeptics that there's times that we're not going to be able to quantify things as much as we would like, and it may be that in-person is absolutely still needed at times, but I think there's a lot of benefits to focusing on different things with the teleneurology visit that actually is additive and not subtractive.

    I think that you're obviously staring at a webcam, and so for a lot of people that may be very impersonal, so there's a whole different demeanor that you have to take then in that visit to make it still very interactive. But to me, it allows me that. Once you get over the weird barrier of we're not in the same room, I think you do focus on things that are what's important to the patient. I can be documenting, but looking at them and I'm a little less wedded to it. My screens are not that I have to be looking at them to look at the patient. I think that's a huge benefit.

    Then, it's also, from a patient perspective. I focus primarily on multiple sclerosis and some of my patients have a pretty significant amount of disability, and so they may want to come in or they may want to talk to me about some worsening symptoms that are maybe bladder or bowel-related that I'm not going to have a lot of in an exam, but it's hard for them to get into the office. Where for a patient, if they say, "I really just want to talk to you for 20 minutes about the symptom management," it affords them the opportunity to actually build more of a physician-patient relationship because they don't have to find transportation and get to me, or they're two hours away. If anything, it can augment that physician-patient relation because there are not as many barriers with the in-office technology, the need to check those boxes, the barriers from the patient perspective of being actually able to get in and communicate with me more regularly. Again, if it's done right, I think that there's that opportunity to actually have a better interaction with patients.

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