Telemedicine and MS

Editor's Note: This article was written on April 2, 2020. Further developments in what we know about the Coronavirus are continuously emerging.

The COVID-19 pandemic has brought treatment for medical conditions such as multiple sclerosis to a screeching halt in many places. The majority of us live in states that have asked or even ordered us not to leave home unless it is to go to the grocery for food or essential services. Staying home and not exposing ourselves to the possibility of crossing paths with the COVID germs includes staying out of doctor offices, especially those that are in hospital clinic settings. Anyplace where other people go and could pass the virus are to be avoided.

Many doctors are switching to telemedicine

Many doctors, including MS neurologists, are taking up the challenge of not seeing patients in person and are switching to telemedicine for safety reasons. My husband had a routine appointment with his pulmonologist that was done via the internet and telemedicine just this week. All types of doctors from primary care to specialists are offering their services via telemedicine. I reached out to two neurologists who are active on social media and already comfortable being on the internet, to find out how they might view telemedicine now that we’re not supposed to leave home.

Hearing from Dr. Singer and Dr. Boster

Barry Singer MD, Director, The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis and Aaron Boster, MD, The Boster Center for Multiple Sclerosis, Columbus shared their initial views and insights into telemedicine and MS care. Neither doctor had telemedicine as part of their clinical care plans and both have only started doing visits via the internet about the middle of March, a brief two weeks before our interviews.

Finding the good

Although the situation for having telemedicine visits isn’t ideal, Dr. Boster and Dr. Singer each spoke about the positive personal side of connecting with patients and their families via the internet. “The video feature also gives me insights into their home environment from city apartments to country farms and from living alone to living with extended family. I also get to hear from significant others that don't come to appointments regularly,” said Dr. Singer.

Doctors can learn more about their patients through tele-visits

Dr. Boster said, “This harkens back to the days of home visits for doctors. I have learned a lot from seeing patient environments. For example, there is a gentleman I took care of for many years, and I had no clue he has a passion for 70’s rock, but during our tele-visit I saw he had at least 40 framed posters from concerts he had been to. I learn more about the person by seeing their environment, and it doesn’t detract from our appointment.”

Patient safety concerns

Dr. Singer acknowledged two important safety aspects of telemedicine. “Virtual appointments are truly about keeping patients safe during this COVID-19 pandemic. The video interaction allows me to communicate better with my MS patients than just by phone. The video appointments on Zoom and FaceTime allow me to develop a COVID-19 pandemic plan with my patients to maximize safety while reassuring my patients,” he said.

Dr. Boster says the efficiency of a telemedicine visit is high and “85% of what you need to learn, you can learn on camera. I can discuss the need to order MRIs, tests, infusions, and even drug changes through the camera. If I didn’t have this tool, I wouldn’t be able to do this. Telemedicine makes that possible when it wouldn’t be possible because it’s not safe right now for people to come in person.”

Unexpected benefits

I asked them both if there was anything that has surprised them using telemedicine. Dr. Singer was surprised, saying, “The vast majority of patients have been happy with the experience, especially those patients with 7-hour roundtrip drives!”

Dr. Boster said he has also been surprised. “I had a new consult today, and the daughter dialed in from another state - we were all on the screen like the Brady Bunch squares. It was a cool family experience. I wouldn’t have assumed that I could have moments like this before I experienced them with telemedicine.”

Post-pandemic telemedicine

After the COVID-19 risk quiets down, do they see a future for telemedicine in neurology? Dr. Singer said he views telemedicine as a “good option for rural care; perhaps an option for every other appointment for those who can't drive.” Dr. Boster also said he thinks there is a future use for telemedicine. “I would love to see a hybrid model where I would see the patient at least once annually in person and then every other time on camera. But for me, I still want to shake a hand, give a hug, and be in the same space with my patients, so it can't ever totally replace an office visit.”

Both Dr. Singer and Dr. Boster have a very active online presence. You can connect with Dr. Singer via Twitter @drbarrysinger and subscribe to his MS Living Well Podcast series.

Connect with Dr. Boster via Twitter @AaronBosterMD or learn more about MS on his YouTube channel with over 20,000 followers.

Wishing you well,

Laura