A famous neurologist Donald Calne puts it brilliantly: “ The essential difference between emotion and reason is that emotion leads to action while reason leads to conclusions.” Quiet applicable for the recent switch in healthcare that has created different mechanisms of reaching a conclusion for a neurological diagnosis albeit the emotional trust is yet to be gained by many as we move into the ‘new normal ‘ of teleneurology. So what does this shift mean? How is it going to help patients across the globe? Lets look at the answers below.
Q1. Can teleneurology be considered as an effective tool in reducing the ratio of just 1 neurologist per 5-lakh populations in India and also to cater to the rural areas where good specialists are extremely rare?
Definitely! Teleneurology has been a boon for people living in remote locations especially from the aspect of gaining access to specialists that were previously a huge challenge. Now, with advancements in teleconferencing technologies and online consultations, conducting a neurological examination and analysing medical history of the patients can be done from the comfort of our homes. This also makes quality care available within minutes that have helped people get the right care at the right time. Patients can get a good qualified senior expert neurologist to examine their medical history from any corner of the world thereby bridging the existing gap stated in the question above. The pandemic situation that has made everyone averse to visiting hospitals and the OPDs has cause teleneurology to be a fast paced change, even though its use cases are niche for now, it is likely to stay in the long run.
Q2. Patients often feel: “I should see a doctor in person and get diagnosed properly as I am not sure how the online diagnosis is going to be and whether that advice is going to be good enough”. So, is there a change in mindset required not just from doctors, but also from patients to accept teleneurology?
The conditions that can be treated through teleneurology have been discussed in one of our previous blogs: https://icardin.com/2021/07/27/providing-neurological-care-via-tele-neurology/ from an acceptance point, patients need to be hand held with patience during an online consultation. It is important for the doctors to assure them through this mode about the severity of a condition and what can actually be taken up online. Secondly, the pandemic situation has kind of made patients and doctors swiftly move to teleneurology and both are still in the process of figuring out what diseases can be consulted without the ‘in person’ tests and which otherwise.
Q4. A lot of patients often ask that “Is it a normal stroke?” “How bad is the stroke?” How is it possible that a neuro expert can address all such concerns over a video call? Do we need to transfer the patient from one location to another?
In these situations, how does a neurologist console a patient?
Firstly, we all need to understand that our brain cells require a lot of energy. Chances of an irreversible damage are high when our brain does not receive blood supply for 8 minutes or so. In acute management, generally giving a thrombolytic agent and a clot buster agent to the stroke patient helps arteries to expand. Now it all depends on factors like the thickness of the arteries that is actually affected. If it were a small artery, which is affected, which we may not be able to detect through a CT scan, then the deficit would be minimum but, if a large artery is obstructed or occluded, then the patient will have a prominent stroke.
When we thrombolyse the patient, we always hope for some improvement or at least limiting the damage. So, whatever was going to get damaged further, after the treatment it will slow down and not progress that much. Limiting the damage is also equally important as reversing it completely, because the morbidity associated with stroke is tremendous. The patient has to remain bed bound for almost the rest of his life. Bottomline, in any situation, these factors and observations need to be conveyed correctly to patients and their families so that they can deal better with the situation.
Q5. For a lot of patients who have been suffering from dementia, tele neurology extends support for them as well. Many people may have come across a situation where assessment is done seamlessly through a telephone interview or a tele conference. What is the effectiveness of a treatment for patients with dementia and the kind of care that is required from the family members? Do tele communication actually prove to be a good support system for this?
Most of the anxiety about dementia is forgetfulness. The primary concern of a caregiver is whether they will also suffer from the same. Secondly, they also want to know what can be done to reverse the condition of their patient right away. It is advisable to get all the family members together and explain important points about dementia such as the signs, symptoms and stages or how do you take care of such patients. It’s good to talk! They always want to be heard; the relatives also want to be heard. We should not forget that in India, we are more social in terms of taking care of our loved ones. We try and stay with them, which is not so in the so-called western world, where there are institutes assigned to cater to dementia patients especially at an old age. Here the care and attention from family members is consistent hence the awareness, dos and
don’ts also need to be consistent. This clarification will help them reduce their anxiety and fear of having dementia in future and the associated complications, because as such, for dementia in India or in the world, there is no fixed treatment. You can only give supportive treatment as of now. Tele communications actually help in keeping the continuity of touching base with patients and their caregivers alike.
Q8. What are some of the rarest neurological disorders and how should we advice family members to deal with them?
Generally rare neurological disorders tend to be genetic, for example a patient having Pompe disease. This is a muscle disorder, more accurately described as a metabolic disorder causing accumulation of fat in muscles. Once the muscles start being replaced by fat, they progressively become weak. Eating, drinking and even breathing gets affected. Whenever the patient visits a clinic for the first time with such a condition its hard for doctors to convey this as there is not cure for Pompe and giving a degenerative diagnosis is like giving a death sentence to the patient sometimes. But there is another way to go about it.
Give your patients a good example like “somebody has recovered”. It boosts the morale of the patient and you don’t need to talk about it in a degenerative way, you just have to match up to your patient’s psyche and motivate them. The doctor should also make it a point in the first meeting to convey to the patient’s family that condition may progress. There are very few facilities or treatment options that are available worldwide for Pompe. We can hope that the research comes up with something good soon and proper medicine for this condition comes through.
It is very important to evaluate all other treatable disorders, which are not that rare; before we end up labelling them as a rare neurological disorder.
Dr. Amit Pande, our neurologist mentions that there is a statement in neurology – “The younger you are, the more headaches you see. The older you are, the more degenerative disorders you see, or the rarer diseases you see”. There’s one more statement, which goes like – “An experienced neurologist has got one medicine for many diseases whereas a wise neurologist has got many medicines for one disease. It all depends on the experience and how you give care to your patients”!