During the COVID-19 pandemic, all neurologic care is considered essential, but not all requires an in-person consultation. These guidelines help doctors and patients determine which type of visit is best.
Amid the COVID-19 pandemic, public officials have used the terms essential and nonessential to describe the types of businesses that should be open or closed and the types of services that should continue as planned or be canceled or delayed. For example, hospitals, pharmacies, and grocery stores are considered essential and remain open, while movie theaters and hair salons are not and have been closed for weeks. When it comes to appointments, especially those related to health, determining what is essential or nonessential is more challenging.
Neurologists and other physicians recognize that all doctor’s appointments are important, and no patient’s health or medical needs will be ignored during this time. And it is critical that patients continue to reach out to their doctors, especially if symptoms change or new ones appear. Neurologists can then determine what type of visit—a telephone call, a video visit, an in-person consultation, or hospitalization—each patient needs. This is based on several factors, including patients’ conditions, reasons for the appointment, and whether patients have underlying medical conditions that could put them at risk for severe complications from COVID-19.
For example, a patient with well-controlled epilepsy who has questions and wants to discuss non-urgent future plans would normally be considered a routine visit. During COVID-19, that visit could be delayed or handled over the telephone. On the other end of the spectrum, a person who had a stroke three months ago and is currently experiencing temporary vision loss in one eye will need an urgent in-person evaluation so the physician can examine the back of the eye to determine the cause.
Some visits fall between this spectrum. In these cases, office staff may arrange a virtual or telemedicine appointment to determine the next best step. Consider, for example, a patient with poorly controlled migraine headaches who has worsening pain as well as moderate asthma who had scheduled an office visit prior to the pandemic. During the pandemic, the neurologist would schedule a video visit to see if the patient’s headaches can be controlled without an in-person visit since the patient’s asthma puts her at risk for complications if infected by the coronavirus.
Telemedicine is proving an effective way to determine important next steps such as tests or in-person visits and whether things can wait until the risk for COVID-19 diminishes. In my own practice, I had a patient with an immune-related disorder who was experiencing double vision, normally a concerning symptom that would have necessitated an in-person visit. Instead, we set up a video call during which I learned that the patient’s spouse has severe heart disease and was awaiting a transplant. Given the situation, we agreed that a blood draw at a lab or clinic was too risky. Instead, I evaluated his eye movements and asked him to check in with me immediately if any new symptoms appeared. We also scheduled a follow-up video appointment three weeks later. Our virtual visit allowed me to determine the urgency and balance the pros (in-person examination or testing) and cons (risk of exposure to COVID-19) and proceed accordingly.
In every circumstance, the goal is the safety of the patient, staff, and community at large. It is a necessary balancing act during the pandemic. Rest assured, the neurology community is in this with its patients, whose care and well-being are paramount.
COVID-19 (Coronavirus) and Neurologic Disease Resource Center
