Diagnosing MS During a Pandemic: UK vs. US

Diagnosing MS During a Pandemic: UK vs. US
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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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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Diagnosed with MS at age 32 in 1980, Ed has written the “MS Wire” column for Multiple Sclerosis News Today since August 2016. He presents timely information on MS, blended with personal experiences. Before retiring from full-time work in 2012, Tobias spent more than four decades in broadcast and on-line newsrooms as a manager, reporter, and radio news anchor. He’s won several national broadcast awards. As an MS patient communicator, Ed consults with healthcare and social media companies. He’s the author of “We’re Not Drunk, We Have MS: A tool kit for people living with multiple sclerosis.” Ed and his wife split time between the Washington, D.C. suburbs and Florida’s Gulf Coast.
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Diagnosed with MS at age 32 in 1980, Ed has written the “MS Wire” column for Multiple Sclerosis News Today since August 2016. He presents timely information on MS, blended with personal experiences. Before retiring from full-time work in 2012, Tobias spent more than four decades in broadcast and on-line newsrooms as a manager, reporter, and radio news anchor. He’s won several national broadcast awards. As an MS patient communicator, Ed consults with healthcare and social media companies. He’s the author of “We’re Not Drunk, We Have MS: A tool kit for people living with multiple sclerosis.” Ed and his wife split time between the Washington, D.C. suburbs and Florida’s Gulf Coast.

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7 comments

  1. Clare McKenzie says:

    Before the start of Lockdown, I booked a private appointment for some physical therapy exercises to improve my walking since being diagnosed with RRMS. It worked really well for me and I have recommended this method to other friends.

    Fast forward, when the NHS finally got back to me during Lockdown, about physical therapy, I received a call and a fact sheet! I was disappointed it took over 4 months for me to receive the call. Luckily I am in reasonably good health.

    For those who are newly diagnosed, I strongly believe that face-to-face meetings are essential. There is so much to discuss and understand. Knowing who your MS Village are is reassuring and comforting.

    • Ed Tobias says:

      Hi Clare,

      Thanks for sharing this information. I took the liberty of removing the contact info for the physical therapist, as the website can’t vouch for providers or services. If readers are interested, of course, they can message you directly.

      Ed

  2. Mammy Y says:

    My neuro who has seen me only once and never seen me walk or evaluated my gait, had a telephone visit with me during which she said “Huh, never heard of that”, when I described something that happens occasionally. The call lasted 15 minutes and ended when she said she would see me in two years. She is on staff at at major mid Atlantic university which purports to have a MS clinic. Although I know my gait is slowly worsening, she will not see me in two years; I will never return. When I have new or worsening symptoms, I will search for a new neurologist.

  3. Cindy Cunningham says:

    This is a really interesting topic, thank you for the article.
    I have had both types of appointments with my MS neurologist (and other providers) since the pandemic began, and I can tell you without a doubt that I prefer in-person visits.
    My visits were with my established and familiar doctor, they were just as long as always, they included one-on-one discussion, and followed the usual patterns and protocols. Yet, as alluded to in the article, something was “missing”.
    In spite of high-quality video and audio, and no matter how hard we tried to treat it like any other visit, we just weren’t able to make the same connection or achieve the same rapport we normally experience. My physician wasn’t able to test my reflexes, balance, and coordination. He could not fully observe my gait, or Intuitively read my emotional state and sense of well-being. For my part, I felt less comfortable talking about my condition and any concerns I had. For whatever reason, I was far less inclined to trust a talking head on a video screen than the same head attached to a tangible, corporeal human being. If I had to choose one word to describe exactly what a virtual visit is “missing”, it would have to be AUTHENTICITY.

    • Ed Tobias says:

      Hi Cindy,

      I think you’ve captured my feelings. There are some virtual exams, for simple problems, where that missing “connection” doesn’t matter. There are also times when, if travel distance or disease spread are a factor, something is better than nothing. If it’s possible, however, I’ll make the effort to be there in person.

      Ed

  4. christi says:

    I have had ms since 1985. 27 years old.
    Doing a virtual visit has been easier for me. Someone has to drive me and transport me in. The visit is hard on me.

    Rehab helps me the best. They give my nuerologist a weekly update. Everyone has mask and gloves on. And a couple patients at a time.

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