Diagnosing MS During a Pandemic: UK vs. US

Editor’s note: Previously, this piece stated that Dr. Ide Smets theorized a transition to telemedicine as the standard of care could cause decreased life expectancy in the U.K. of up to 30 years. The piece has been corrected to state that such a change could result in a decreased life expectancy 30 years from now.

I had an annual appointment with my primary care physician last week, my first since COVID-19 attacked the world.

Things have changed in her office, of course, but not drastically. Everyone, including patients and staff, was wearing a mask. I was asked to wait in the hallway outside the office until the waiting room emptied a bit. Chairs inside were spaced apart more than they were in the old days.

Face-to-face or telemedicine?

My primary care physician offers video and phone consultations, and I once texted her a picture of an odd-looking toe. But we both prefer face-to-face appointments. An annual physical exam just needs to be, well, physical.

My neurologist doesn’t offer virtual appointments at all. She thinks she loses too much if she doesn’t watch her MS patients walk the walk, such as it is, and reach out to touch her moving finger, among the other MS tests. On the other hand, Dr. Aaron Boster, whose virtual visits I wrote about last April, told me a few days ago that he’s still seeing up to 75% of his patients virtually. Other physicians also are telemedicine fans.

Virtual exams are now the rule in the UK

I mention all of this because of a column I recently read by neurologist Ide Smets on the BartsMS Blog. Smets works in London, for the U.K.’s National Health Service (NHS). When it comes to examining and treating people with MS during the COVID-19 pandemic, the U.S. and the U.K. seem to be an ocean apart.

Smets says that she and her NHS colleagues have been required to use telemedicine — sometimes video, but usually just a phone call — for nearly 99% of their patient visits since March, and she’s not happy about it. She’s posted an example of the process that now must be followed by someone seeking an MS diagnosis in the U.K.

For example, a patient would have to contact a general practitioner for a telephone evaluation. If symptoms possibly indicate MS, a referral is made to a general neurology consultant. Getting that appointment could take weeks or even months.

After this virtual appointment, the general neurologist orders an MRI.

Once the scan is done, another virtual appointment is made with the general neurologist, who then issues a referral to a neurologist specializing in MS. That physician would decide whether to diagnose MS after another virtual appointment. 

Finally, treatments are ordered. All of this takes place without a face-to-face, in-person meeting between patient and doctor. 

Advantages and disadvantages of telemedicine

“In the COVID-19 epoch, you can thus be diagnosed with MS and treated for the condition without ever seeing an MS consultant or nurse in real-life,” Smets writes.

Telemedicine has benefits, she says, such as eliminating the risk of COVID-19 transmission, avoiding mass transit, and reducing cost. But there are also serious disadvantages, such as issuing diagnoses based on medical records and tests alone, which might prompt the belief by some that a hospital is a dangerous place. Both patients and doctors also may feel like something is missing.

What really concerns Smets is that the transition to virtual healthcare is “huge” and the “new normal” in many places these days. She worries that this may be detrimental to the long-term health of U.K. residents, and that today’s new normal might become tomorrow’s standard of care. And that, she claims, could result in a decrease in life expectancy in the U.K. 30 years from now.

Thoughts?

It seems there may be space for middle ground. Boster believes that routine MS exams can be done remotely, and I agree, though I prefer in-person appointments. My primary care physician has been doing some virtual office visits since way before COVID-19 hit. Perhaps NHS staff could be more open to this sort of thing.

But I’m looking at this from the other side of the pond. How do you feel about telemedicine? Do you agree with Smets’ prediction that it will reduce life expectancy? Have you had a virtual visit? Please share your thoughts below or start your own discussion at our MS News Today Forums.

You’re also invited to visit my personal blog at www.themswire.com.

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