Teleneurology is the new and vastly expanding practice of neurology involving the use of technology and/or video chat to improve access to services. With an ever-increasing aging population there is and will continue to be a shortage of neurologists in the United States. Teleneurology has increased patient access to neurologists especially in rural areas but also in urban and suburban areas.
Practicing as a teleneurologist for the last two years I can log on to secure video chats compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I see patients in Florida, New Hampshire, North Carolina, or other states where I have a medical license. I connect within minutes, take a history from the patient or family, and do a physical exam with the help of trained staff at the hospital.
For acute stroke, I can give tissue plasminogen activator (tPA) to patients in rural areas or major cities where a neurologist is not physically present. I can also treat conditions including status epilepticus, headaches/migraines, multiple sclerosis, myasthenia gravis, or other neurological disorders. I have access to view the electronic medical records of patients including imaging, lab work, and other testing. I have the ability to put in orders and to function as the inpatient neurology consultant.
After seeing a patient in a hospital in one state I can see a patient at another hospital in another state within minutes. The use of teleneurology allows a neurologist to be present in an instant to see a patient. For a neurologist to be physically present is not as easy and takes more time. Teleneurology leverages the use of technology to quickly have a neurologist present to see a patient in emergency cases or routine cases.
The physician-patient relationship can be created with the use of teleneurology. The trust between a physician and patient can also be established. The physician must be able to have compassion for patients in addition to good listening skills. The physician should look directly at the patient, introduce himself or herself, listen attentively, communicate directly to the patient/family, and answer all questions appropriately. A physician’s medical knowledge and compassion for the patient must be come across in the teleneurology visit.
Although teleneurology is a great new field of medicine, there are limitations. The reliability of technology varies depending upon the connection speeds on both ends. Quality trained hospital staff are needed to help the teleneurologist with the technology and the exam. The willingness of the patient to accept teleneurology is another limiting factor. Physicians must also accept teleneurology themselves. As time goes on more people experience teleneurology and tend to embrace it.
Teleneurology offers compassionate, patient-centered care just as an in-person visit. This provides a satisfying experience to me as a neurologist in helping patients with their medical conditions. Seeing improvements in patients across different states can be even more gratifying. The scope with which I practice is greater than what I could do in one hospital system. I feel as though I am physically present in the room with the patient even though I am in the comfort and convenience of my own home office. I hope teleneurology will continue to grow to treat more patients in shorter times who may not have access otherwise.
Puja Aggarwal is a neurologist.
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