Curious what the neurologist's opinions on teleneurology are. The ones we use in our community hospital do not write orders, but give "recommendations."
Some physicians do not use them and patients seem to hate them and ask for a live body neurologist to come see them.
Our only neurologists sees inpatients from 8 to 5. Afterhours and weekends it is the teleneurology TV that gets wheeled in.
Looking forward to your opinions.
I’m a little confused about this, but I’ll take a shot. I’m confused because you seem to be asking this with some sort of malevolent motivation that’s implied by “patients seem to hate them” and “neurologists sees inpatients from 8 to 5.” Or you’re just totally clueless as to what its like being a patient facing doctor. So I’ll take the latter, and based on your use of the word and scare quotes around “recommendations” this is likely. So I’ll assume you really are honest, and add to the already excellent responses above.
Neurologists form a very rare field. 1% of med students enter neurology, and usually for the best reasons imaginable: they love the nervous system, see the elegance of neurological thought processes, and want to help people stricken with some of the worst diseases in the book, with symptoms that literally strike the core of their personhood. These conditions are sadly very common. If you add together headaches, peripheral nerve disorders, movement disorders, dementia, epilepsy, MS and ill explained neurological symptoms or spells (non-neuro stuff like psych/conversion/pre-syncope/hypochondriasis), then you can appreciate how there are many folks with problems and how few of us. Neurologists are busy, even without mentioning stroke. There are very few areas in this country where the population is adequately served by neurology. All these areas are nice places to live and raise a family: up and down the East and Wast coasts and big cities in the Midwest. I live in one of these places. I had about a 3 month waiting list and then I had to restrict my practice towards my sub specialty. As an aside, market forces would account for this, but this is medicine.
And that’s just outpt. Inpatient can be very demanding. Why is this 87 year old with a UTI confused? That’s easy, but the family and the residents think it was a stroke! Will this 50 year old in a coma after a cardiac arrest wake up? That’s hard, and harder to talk about. Add to that stroke call. Here one can make huge differences. Using tPA can be absolutely life saving. And there’s a NNT of 3 for a measurable improvement between bedbound and able to walk with assist, or cane and no cane, or symptoms that limit work and able to work. But again, what are patients who just have the ill fortune to have their stroke in Alaska, Nevada, Utah, and anywhere else that’s totally remote?
So telemedicine! Telemedicine offers an amazing way to give tPA to someone in Montana. Thankfully regulations that limited payment to neurologists (and others who offer telemedicine services) are changing, so we’re going to see more of it. Personally I couldn’t be more thrilled. This is an excellent way to help many more patients: tPA is amazingly under utilized. The last I looked only 2 to 3 percent of acute strokes get it. Giving it takes remarkable diagnostic skill, a deep knowledge of relevant contraindications and mimics, and a mind towards faster is better while knowing that the drug can and does kill, particularly when given outside criteria. And given the IA approaches, more knowledge to figure out who should get a CTA and go to cath. So more neurologists will get involved and a new revenue stream will occur.
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As to patients not liking telemedicine. Perhaps they would like being hemiplegic for the remainder of their days? But never mind, I think patient satisfaction is very high for telemedicine from what I saw when we did it. Folks were very grateful for the expertise and help. Want a live body? Move out of rural Iowa.
Recommendations: a consultant writes a note with recommendations. There exists one primary team who should weigh these specialist recs with other germane factors and other specialists. They come up with a plan. This is medicine 101. But sometimes consultants take a more forceful approach, particularly in their field. For example, if I have a stroke patient on my service after tPA, I would not mind it at all if the cardiologist were to adjust lasix or the ID doc just put the orders in for abx. In general, I like the clarity of recommendations as it entails consultants have an advisory role and in cases of conflict do not have decision rights.
8 to 5: sounds reasonable. Was that a dig? The hospital likely has a contract with a hub hospital for after hours.
