Traditionally, outpatient care at UCLA Neurology had several mainstays no matter what diagnosis was evaluated and treated: patients would come to their doctors in the clinic location, and have a thorough history and hands-on exam. This exam and history helped the neurologist start formulating a diagnosis and determine beneficial testing. For some specialty care patients, coming to the clinic in person has meant hardship due to traveling long distances to see an expert neurologist.
In the time of the COVID-19 pandemic, physicians and patients had to learn quickly how to cope with physical distancing. Video and telephone visits are currently largely replacing the in-person consultation. Because the UCLA Neurology clinics had been performing some video visits prior to COVID-19, the clinic was equipped for these visits and able to quickly shift focus. Training of doctors and patients in utilizing telehealth technologies was established. Now, in the “New Normal”, more than 90% of our visits are conducted via video or phone.
Not all physicians and patients immediately liked the changes, and the pros and cons of these telehealth visit types became immediately clear. Patients appreciated the opportunity to stay home and use the option of video to still see the face of their doctor, but some miss the direct interaction. Neurologists learned to place more weight on the patient history and verbal discussion, as the detailed neurological exam became limited to observational examination (such as watching the patient walk). Neurologists missed the direct contact, too, and know that there are times when exams and procedures must be conducted in person to provide proper patient care. As noted in Dr. Hinman’s account, a survey of our patients who had telemedicine visits found that three-quarters were satisfied or very satisfied and would like to do telemedicine again.
As we move into our second month of physical distancing, we have learned that telehealth cannot and should not replace all in-person visits. Beyond the current pandemic, telehealth will change our clinics. It will continue to play a vital role in our patient care for many new and follow up visits, including frail patients and when caregivers are not available for transportation. Enthusiasm for this form of patient care has grown and having this new care option available and using it appropriately can be of great benefit.