Neurology Today: COVID-19: How Neurologists Are Defining Those ‘Essential’ Visits
By Thomas R. Collins
Neurologists around the country—from migraine specialists to epileptologists—are overhauling the way they deliver their patient care during the COVID-19 outbreak, mostly transitioning from face-to-face visits to video or telephone visits. They also face decisions on which circumstances require an in-person visit with a physician, or a trip to the hospital, despite the infection risk from the novel coronavirus.
The sudden change has been prompted by recommendations—and now, in many states, outright orders—to maintain social distance.
"What we've been asked to do is categorize who must be seen in person, who could do a phone call and who could do telemedicine," said Jennifer Bickel, MD, FAAN, chief of the headache section at Children's Mercy Hospital in Kansas City. "Suddenly one of the risks of doing the procedure is no longer the typical risk versus benefit of doing the nerve block. Now it is the risk of obtaining the virus. Suddenly, everything needs to be weighed differently because now there is risk for fatality in inpatient visits, which was not something we had before."
Dr. Bickel said that the default is that all migraine cases, for instance, are to be done by telemedicine and not treated with procedures requiring a physical visit. But she added that decisions are made on a case-by-case basis.
She said that if a child's headaches becomes severe because they're not getting a procedure—such as Botox or a nerve block—and they are a proven strong responder to that procedure, then they can come in during specific periods that are available for in-person visits.
"It's not that we've said, 'Absolutely never,'" she said. "With no clear algorithms for first-, second- and third-line treatments for pediatric migraine, physicians are now more likely to attempt a treatment for patients that don't involve a physical procedure, she added.
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