Neurology in the Era of Virtual Care – an Interview with Dr. Sara Mitchell

The impact of the COVID-19 pandemic has been felt far and wide. Physical distancing guidelines have affected all aspects of day-to-day life, even healthcare services. Virtual healthcare, powered by both digital technologies and by necessity, is estimated by some to have progressed by a decade in the year since the pandemic hit. This “revolution” has been felt by both the people providing the care and those receiving the care.

“When the pandemic started, we went into crisis mode where 90% of the work was being done remotely. My practice today, a year later, is probably 65%/35% – virtual/in person. Clinically, there are many things that can be accomplished through virtual care. But when a thorough neurological exam is required, when we need to rely on additional cues, this can present challenges. Particularly for atypical dementias… when we are testing reflexes, examining muscle tone, listening for nuances in speech, it is hard to replicate the in-person experience” said Dr. Sara Mitchell¹, an ONDRI collaborator.

Virtual technologies are not all the same

Dr. Mitchell makes a distinction between virtual technologies. The telephone is most widely used for virtual consultations and offers the benefit of almost universal access. But it has drawbacks: muffled voices – where one person is hard to tell from another – no ability to see what is happening.

Video-based technologies allow the clinician to observe more behaviours and the home environment, for further clues on how the patient is functioning. As well, video more easily allows other specialists or trainees to participate in the patient’s care discussions. However, video technologies may be hard to use for people living with dementia. This is an issue of both access to the technologies and, equally importantly, the ability to use them. People living with dementia often require hands-on help with participating in video consultations.

Dr. Mitchell is senior author of a new journal article entitled “Virtual care for patients with Alzheimer disease and related dementias during the COVID-19 era and beyond”². This article, published in the Canadian Medical Association Journal (CMAJ), expands on these concepts, based on an extensive literature review.

Looking to the future

The fast pace of development in virtual care over the past year may be one of the ‘silver linings’ of the COVID pandemic.

Governments quickly made accommodations that were previously under discussion for many years; for example, opening up billing codes that allow doctors to charge for virtual consultations.

As the most urgent impacts of the pandemic were felt in long-term-care facilities, some hospitals set up virtual consultations for residents.  Through these consultations with specialists, some residents, such as those living with dementia who may have been experiencing delirium, were able to avoid the emergency room. These new processes allowed these residents to stay in their homes or facilities, thereby reducing the risk of hospital-borne infections.

Will this type of practice continue?

“This has been a challenging time for all of us in the healthcare system, certainly on the patient side, but also on the physician and broader healthcare system side. I hope that the best innovations that have come out of necessity during the pandemic, such as the increased use of virtual care tools where indicated, will be around to stay. Further, I hope that these innovations will be planned and supported, with broad stakeholder consultation, by the Ontario healthcare system”, said Dr. Mitchell.