Preparing for My First Virtual Neurology Visit

Although I was diagnosed with multiple sclerosis 15 years ago and I’ve only had one relapse during the past 8 years, I still see my main neurology team every 6 months. I remember clearly when I finally “graduated” to neuro appointments every 6 months versus every 3 months during the time that my disease was much more active. That graduation was exciting.

My regular 6-month neurology appointment

Since my disease is so stable, my neurology appointments are almost always the same. Much of the actual exam is talking, some hands-on evaluations, and mostly close observation. My normal 6-month visit was scheduled for last week, and it really wasn’t expected to be any different than usual. Basically all I really needed was refills for each of my prescriptions.

Switching to a virtual neurology appointment

But this time was anything but normal when my in-person visit was switched to a telehealth, virtual visit due to the COVID-19 pandemic and stay-at-home orders in my state.

A typical neuro visit for me

For a typical neurology appointment, I submit forms that detail much of the following information:

• Current medication list, including any refills I might need
• Current MS symptoms, including the intensity of those symptoms
• Results from routine laboratory tests conducted by other physicians
• Additional updates from any tests, procedures, new diagnoses, etc. since the last visit
• Top 3 questions on my mind

The steps taken during my in-person neuro visits

Once it’s my turn to be called back in the office — assuming it’s an in-person meeting — the general nurse times my walk down the hall, has me step on the weight scale, takes my blood pressure and temperature, and retrieves the completed forms to give to the doctor or nurse.

Seeing the MS nurse practitioner for a neurological exam

The neurologist, or in my case the MS nurse practitioner, comes in to talk with me a bit. Then she conducts a neurological exam. I know that there are some tests that we don’t do during the exam that other MS patients may encounter — for example, I no longer have to do the Romberg test and can’t remember the last time I was asked to stand on one foot to measure balance. The exam seems to be somewhat catered to my specific situation.

Checking my strength, reflexes, and movement

In short, the nurse checks my strength and reflexes, as well as movement. She always has to stick me with the safety pin, and I usually never flinch due to persistent numbness in all four limbs. The random time that I actually feel sharpness is a good thing. Oh, and I do have to walk on my tiptoes, on my heels, and with feet tandem. After a quick exam, we usually talk about what my needs or concerns may be at the time.

Rocky transition and prep for a virtual visit

At first, I wondered, how would such an exam be conducted through the computer screen?

When my routine appointment was recently switched from an in-person appointment to a virtual one, the first glitch I encountered was that the doctor’s office had a long-standing policy to not communicate through email. Messages sent through the patient portal were acceptable. There was one time in the past that an MRI order was even sent to me through the portal when the office staff forgot to give it to me before I left after an appointment.

Communicating through a patient portal

Communication through the portal seems simple enough and I thought it would be easy enough to submit the information they needed ahead of time. But after downloading and filling out the typical paperwork and then uploading documents through the portal attached to a message, I learned that office policy prohibited them from downloading MY PDFs into their system. A staff member called me and asked if I could FAX the material over. Um, no I couldn’t. I could easily email, but they don’t do email.

Changing policies to accommodate our needs

Eventually, an office policy change had to occur to allow them to download the attachments I had so carefully prepared and sent. We find ourselves in a new era and accommodations must be made.

Being asked to join the virtual meeting early

Once the official appointment was switched over, I was informed that I would need to log on to the virtual meeting a full 30 minutes ahead of time!!!! What? I don’t even usually arrive in the office 30 minutes early, and in the days of numerous Zoom and GoToMeetings, who bothers to arrive at a virtual meeting more than 5 minutes early anyways?

Re-iterating information from my completed forms

But I complied. In doing so, I learned that the reason for the extra time was for the general nurse to collect all of the information I had already sent through the portal. For each patient, she had been painstakingly going through each form to ask the questions, have the patient answer, and then write down the responses just to be able to pass along the information to the doctor or MS nurse. Not very efficient, but one way to work around the general lack of fax machines available to the typical patient, I suppose.

The only question I was asked and not prepared for with a quick answer was what was my temperature? Maybe the office will fine-tune their pre-virtual visit routine to ask each person to have vital signs handy (if able) before the visit.

The details of the virtual visit...coming soon

Of course, the story doesn’t end there. What happened during the actual virtual exam? Inquiring minds want to know, I’m sure. I certainly wanted to know before I had my first visit.

That fun bit will be shared in Part 2 of this digital adventure.

Stay well, my friends,

Lisa

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