In the wake of the COVID-19 crisis, the US Department of Health and Human Services relaxed certain rules around telemedicine that have made it more accessible to patients and physicians. Seemingly overnight, it has become the predominant method of providing medical care.

As an example of how fast this transition occurred, prior to COVID-19, the neurology practice at Akron’s Children’s Hospital where I work conducted almost 200 in-person evaluations a day and fewer than five telehealth visits per month. A month later more than 95 percent of our visits were offered via telehealth.

These types of visits may wane if and when the pandemic ends, but telemedicine is most likely here to stay in some form or another. So how do you know when a face-to-face visit with a doctor is necessary despite the risks? Firstly, for anything requiring emergency care. This includes symptoms of stroke or stroke-like episodes, alterations in levels of consciousness, prolonged seizures, decreased alertness or sudden changes in temperament or mood, or sudden onset of imbalance, weakness, or numbness.

Fortunately, you don’t need to decide on you own what requires a visit to a doctor’s office. You can and should confer with your doctor first. This checklist also may help.

Face-to-Face Visits

Certain symptoms
If you experience a sudden intense headache or vision problems such as visual loss, your neurologist may need to look into the back of your eye with a special tool. For neuromuscular diseases, such as myasthenia gravis or neuropathy, your physician may need to conduct tests that require physical interaction. For example, he or she may need to measure your strength and compare the results to a prior examination, determine your ability to feel sensation or temperature, or check your joint position.

First-time evaluation by a new provider
If you are seeing a doctor for the first time, he or she may not feel entirely comfortable using telehealth, especially for symptoms such as worsening gait, a new and debilitating headache, or anything resembling a stroke.

Unusually sick infants
Babies with potentially serious symptoms such as fever, vomiting, decreased alertness or excessive sleepiness, or seizure-like movements may require a hands-on evaluation.

Cognitive limitations
Early features of dementia are almost impossible to assess remotely, even when assisted by a close family member. A doctor may recommend a face-to-face visit to determine if the cognitive changes are significant and require further evaluation.

New onset of mild but serious symptoms
Patients with mild physical signs are more difficult to evaluate than those with abnormal ones. For example, new-onset multiple sclerosis may present with sensory numbness highly suggestive of a spinal cord problem but can only be confirmed by a physical examination and diagnostic testing such as an MRI scan. 

Telehealth Scenarios

Routine visits
Patients with identified but stable medical problems such as well-controlled epilepsy or migraine or a brain tumor that has been in remission for years can be monitored virtually.

Medication management
If you need to manage or change your medication—increase doses of levodopa for Parkinson’s disease or an antiseizure drug for epilepsy, for example—you can consult with your doctor via telemedicine.

Test results
Before the pandemic, providers often called patients to report test results, especially if they were positive. Even results that are complex such as from a genetic test or brain MRI can be handled via telemedicine. Although providers prefer to break bad news in person, most patients want a timely answer rather than waiting.

Simple questions
If a six-minute telephone call can replace a 20-minute office visit, you and your provider both save time. In some cases, your response to a new medication can be assessed with a 15-second video clip sent electronically. Your provider may see that the medication is working well or ask you to increase or decrease the dose and send another video clip in two weeks.

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COVID-19 (Coronavirus) and Neurologic Disease Resource Center