Breaking Down Geographic Barriers with Telemedicine in Brain Injury Care

0:00:06 - Hey, I'm Shane from Shane Smith Law with Tomas. He's one of our attorneys in the concussion and brain injury group here at Shane Smith Law and today we're here on Mind Matters. We're going to be talking about brain injuries and telemedicine and sort of how those two things are intersecting to sort of change some of the standards of care and some of the future care in this area, right?

0:00:27 - Yeah, absolutely, and it's a very, I guess I want to say new.

0:00:32 - I think new is sort of the right thing because I mean, to be quite honest, before COVID I can't think of when I had a telemedicine appointment. That didn't seem silly and I don't want to say useless, but I mean seemed like we were just pretending that the doctor and me were talking, if that makes sense.

0:00:47 - Yeah, I think telemedicine really saves people a lot of time, saves doctors a lot of time. It really makes everything more efficient, because how many times when you go into the doctor's office do you actually make physical contact with the doctor? At the first place it's not very often, unless you're going to a chiropractor.

0:01:02 - Yeah and a lot of times, even when you do see the doctor, you've seen somebody in the front intake and all your stuff. Then you see a nurse who seems like copies exactly what you put on your intake form and then the doctor comes in. You may see the doctor. What two, three, three minutes tops five, whereas some of the telemedicine appointments now you're. I think you actually get more face time with the doctor than you did before.

0:01:21 - Yeah, more face time with the doctor. You're not traveling, you're not, you know, waiting in the doctor's office for an hour to be seen. It's breaking down geographical barriers too.

0:01:32 - So let's talk about that. So what do you mean by the geographic barriers? Because I think that is actually where I think that's where telemedicine shines, honestly is when people are in weird geographic spots. Maybe they're in rural areas, maybe they're just far away from a specialist, because I know years ago not on a on a brain injury case but we need to go see a specialist for one of my kids and it was a pediatric ophthalmologist and I don't think, and I lived in Tennessee and they said there wasn't one for like 200 miles.

0:02:01 - Yeah, yeah. There's some pretty stunning numbers about that when you actually look at in terms of specialists and neurologists in particular, 86.3% of United States counties all the counties in the United States they don't have a neurologist. Give me that number again 86.3%.

0:02:17 - So really, basically what? What you're saying is you have less than a 15% chance of having a neurologist who practices in your county. Yeah, it's.

0:02:25 - It's probably isolated to some of the bigger cities, but if you're living in rural areas, if you're living in suburban areas, you're you're looking at not having a neurologist in your area. Or if you do have one, if you think about all the back load that you have there before you can actually be seen. That's something that we see. A lot of clients goes into their health insurance doctor and they're referred to a neurologist for traumatic brain injury and neurologist says all right, it's June. I can see you in December.

0:02:52 - We've seen that and that's a four or five month window of whatever happens and during that window a lot of times the primary care doc doesn't see you anymore because they're like I referred you out, I can't do anything, I referred you out, so you got no care there, and I've seen clients sort of left like what am I supposed to do?

0:03:10 - Yeah, it's breaking down barriers. Telemedicine is because it's helping those people get access to care that they otherwise would not have been able to get, sooner than they ever would have been able to get, and, I would even argue, at a higher quality than they're able to get, because you're not restricted to the neurologist who has a contract with the local hospital. An hour away, you can see somebody in Las Vegas, you can see somebody from Louisiana, you can see somebody from North Dakota if there are specialists up there. The best in the world.

0:03:37 - So that's what it gives you is the ability to I guess it is doctor shop to look for the specialist who you think can do the best job, but also who can provide the best care for you specifically.

0:03:49 - Right, yeah, I think it's. You know, I can almost say, it's just doctor choosing. You know and that's something that we don't get the opportunity to do a lot of times when we're looking at our healthcare is. You know, we have the luxury of choice in so many areas in life. You can choose what you watch on TV, you can choose what you eat, you can choose you know where you go on the evenings and on the weekends. But when it comes to the most vital things that go on in your life, the things that are going to keep you alive or cause you to die, hey, this is your doctor, You're stuck with it. Good luck.

0:04:17 - Yeah, when you, when you put it like that, it seems crazy yeah.

0:04:20 - It's absolutely nuts and you see how it's something that's denigrated by insurance companies are like oh, you didn't even see the doctor, they didn't even see you in person. Well, actually they saw him on a screen. Yeah, but they got to choose who they got to see and you shouldn't have any problem with that.

0:04:35 - No, because I think about it. I mean, you know, you said the choose things. If I look at, can you imagine the chaos or what would happen if someone in the government came out and said hey, you guys can only drive red Toyota Corolla's. Yeah, and that's your car, Thomas, you don't get to pick, you get that and I get a green. I'm lucky I get a green Ford truck instead, but you got, you know.

0:04:55 - I mean, nobody was staying for that right.

0:04:57 - They said you can only go to this particular restaurant. We'd go crazy. But we let them do it with doctors all the time or at least there's this one doctor who's local to you versus giving you the choice right.

0:05:07 - Yeah, when you think about it, it's remarkable. You know that the type of argument that they're actually making you know, in terms of life or death, your health, your family, your livelihood. This is who you have to use, because I get to choose in America.

0:05:22 - Yeah, yeah, like you said, this is America. We get to make choices all the time. Right, and I've met doctors in the past where I'm like, dude, I wouldn't want you working on me. You know, I mean the doctor who seems super busy, who doesn't seem like he listens to you, or just, you know, looks at a piece of paper but doesn't look at you or doesn't talk to you. I mean, I've been in a doctor's office where I'm not even sure the doctor looked at. You know, looked at me, they looked at my labs, but they didn't ask me any questions.

0:05:45 - You're just the person in room one or the person in room four? You know you're almost a number instead of an actual living breathing human being.

0:05:52 - And when we come to brain injuries and stuff, I think, since this is so much of an injury where you don't just see it, you know, and simple lab work doesn't really show it a lot of times, it requires a doctor who's going to take the time and to talk to the client and listen to the symptoms and correlate it to whatever they can to prove and show that and figure out a treatment path right Absolutely, and it frees them up to have that time is one of the crucial things to think about with telemedicine.

0:06:18 - That doctor's not restricted by, you know, being stuck into an office and having to, you know, rely on a thousand other people to make the wheels turn. They can just see people. They can get things done, and you know it's an application that's not new. This is used in other areas of medicine to remarkable effects. Some of the most important decisions that get made in a person's life happen through telemedicine.

0:06:40 - No, I mean business deals are done by Zoom all the time. Nowadays we let people negotiate big, huge deals. You can almost buy a house with Zoom and DocuSign. You know, I think, about the size of business deals that happen and nobody ever sees anybody else. And why in the world are we going to say that you can't do with medicine, right?

0:06:57 - I mean, we do it in terms of stroke, stroke diagnosis, you know the management of stroke conditions. You know, telemedicine has changed the game, in that that's a condition that requires swift intervention. And you know, with 83.86, 86.3 place, not having a neurologist or a specialist in that area, what are these places supposed to do when someone has a stroke? They've come up with a solution to that?

0:07:17 - No, I've got a good friend of mine. He's a telemedicine emergency room doctor, which I heard him say all that, and I honestly pictured him sort of sitting in a room and looking at cameras and doing all that. But that's not what it is. He's a specialist of some type but he services rural areas, these places that can't afford to have what you know his type of doctor on staff in the middle of the night and he one time told me he was covering, I think, six counties. He was the doctor on call for this issue or his specialty. So you know, the nurse comes in, calls him and he covers it and makes all these decisions all through telemedicine, yeah.

0:07:52 - Yeah, it's allowing greater access to better care, and I don't. That seems like the best thing, right. It seems like more. It seems what we should want. We should want more access for more people to the best doctors that are out there.

0:08:07 - So the telemedicine doctors so can they prescribe medicine after they talk to me and see our patients?

0:08:13 - Yes.

0:08:14 - So they prescribe medicine, they can order tests, they can do all the things a regular doctor can do. The only thing they can't do is what? Put their hands on me?

0:08:21 - The only thing they can't do is put their hands on you and you know, basically touch your body. They can't take your weight.

0:08:28 - They can actually depend on the truth for that, yeah.

0:08:32 - That's a take your word for it on that one. But you know patients aren't there to lie, they're there to, you know, find out what's wrong with them. So that's what our clients are there to figure out what, what, what's going on with their body. So you know they're there to tell the truth and get all the information to the doctors so they can make the best and I've even seen some of these telemedicine doctors.

0:08:51 - they'll have the patients almost do some I don't want to say a physical exam because the doctor's not there, but they will have a patient step back and do certain movements so they can see that and look at it. I mean almost the same as if they were in a room.

0:09:03 - Absolutely yeah, yeah, and get a sense of somebody's posture. You can get a sense that their head is drooping to one side. All of those are things that can be done with telemedicine. It happens in various industries besides just healthcare and doctors. You see that happen with personal trainers. A lot of what you're seeing. You're seeing how somebody moves their body and then you're getting a read on what you need to do to improve this particular aspect of your fitness.

0:09:28 - Lots of different things like that If they're using it, is it commonly accepted in the stroke area. There was a 2018 study in Stroke Magazine that revealed that telestroke services led to faster diagnoses, accurate treatment decisions and, ultimately, better patient outcomes. There's an FDA-approved remote presence robot that allows for high-definition video and audio communication for real-time patient assessment.

0:09:53 - I assume this is a special type of robot in the hospital, these rural areas in particular, to send super images, basically like 4K, 8k video stuff. But I think what's most relevant about that, you told me this magazine, They said it leads to more accurate diagnosis than I would assume a local doctor, who's not a neurologist, making a decision, or a physician's assistant, or a nurse on staff or something else. So they're coming in better, even though it's all telemedicine.

0:10:21 - Yeah, I mean, you think if you had to do it the other way, if you had to do the alternative, you would have essentially, there's somebody taking a picture or video and sending it to a doctor and having them figure it out after the fact, or just getting on the phone with a doctor who lives in one of the 13.7 counties that do have it.

0:10:40 - Yeah, and then explaining it to them.

0:10:42 - It's like, why would we restrict that doctor's ability to save someone's life and you?

0:10:45 - just put it up on the screen and you're like, yep, clearly that's a stroke. Because my assumption is the guy or guy who does it all day, every single day, it's going to be much better at diagnosing a stroke or much better at diagnosing a brain injury, and somebody who does it once a year.

0:10:59 - Yeah, that's some. Yeah, somebody's working a per diem shift at the ER or coming in or hasn't been trained on that particular issue. You have a specialist who's making massive life and death decisions on whether to administer certain medications.

0:11:13 - So it sounds like telemedicine's here to stay.

0:11:16 - Should be and yeah, I think it absolutely is. Hopefully it becomes more and more accepted, I think, as patient outcomes get better and better traumatic brain injuries, in particular, are treated better and better and patient outcomes are improving that we'll definitely see and what I see.

0:11:34 - It comes back to this access of care, because you told the story about yep. I'm a new patient referred to a neurologist I'll see in five months. I mean that's pretty common, honestly. I mean it sounds like a joke for us, but I mean that happens over and over and over.

0:11:50 - Yeah, I can't tell you how many times I've seen it happen. They have a client diagnosed with a brain injury or concussion at the ER. They go see their primary care. Bring their records primary care. I can refer you to a neurologist. Call the neurologist. I can see you in three months, but that's the best I can do.

0:12:08 - Yeah, and I think that's a great reason why, when somebody goes well, why don't you go see the in-person neurologist? Why don't you take the telemedicine neurologist? Well, because this guy couldn't see me for three or four months. This guy could see me in two weeks, right? Yeah, absolutely, and I know I've had issues where you have health issues and you're worried about something. Honestly, once that happens, that's usually on your brain the whole time until you get answers right.

0:12:31 - Yeah, and there's something to be said for cortisol levels and different parts of the physiological reaction of that stress and not knowing what's going on, making your condition worse. At least you have to believe that there's some sort of impact.

0:12:44 - I would totally. And when you think about the effect of an undiagnosed brain injury on a relationship between a husband and wife. I haven't read a study recently about it, but I know it's got to be huge because until it's diagnosed and we have tests that say this is what happened and this is why you're acting this way, we know people are going to just think the other person's acting crazy. Yeah, I mean because I know the impact on relationships for people who have a serious high-concussion brain injury is already very, very high, but undiagnosed, I think has got to be even higher.

0:13:12 - Absolutely, because you've got conflict or strife in a relationship and that alone is bad but then not knowing what's the cause of it or thinking it could be something that happened to me in this accident, and just not being able to find out, not being able to get support or understanding for that can only imagine and makes things so much worse.

0:13:32 - As we talk about it. I think the impact on strokes is huge. It's simple, it's easy and it's easy for everybody to say okay, well, speed is really the issue there in the stroke. How does it affect brain injury stuff?

0:13:44 - Yeah, just like a stroke or much like a stroke TBI's and concussions. They often require immediate attention and swift diagnosis that can significantly impact your future prognosis. Telemedicine can make sure that you get that immediate consultation with a neurologist, which gives you access to early intervention and you know all of those the symptomology, patient history that can be conveyed through a video call, just as what's going on with the stroke.

0:14:12 - Oh yeah, I wouldn't see any issues with that. I mean, that's not much different than honestly you can fill out a form and zip it into the doctor just as easy. You can fill out a form and hand it on a piece of paper, right? Yeah, absolutely so. What are some of the benefits of being seen super quick and early?

0:14:27 - Yeah, I think it's just being able to get the care and the treatment that you need, knowing what's going on with your injury and then being able to be proactive in getting the treatment so that any impact of that injury you can try to negate or mitigate as best as you can. You know, in terms of getting rehabilitation, whether it's cognitive behavioral therapy, or you know different medications or different supplements that are recommended by the doctor. Even IV infusion therapy is something that's been recommended. So just being able to get it taken care of you know, nip it in the bud. You know if you break your leg, you know you don't want to wait three months because that's obviously going to have.

0:15:03 - Yeah, it's easy to see how. And maybe that's where the brain injury victims or the advocacy groups need to step up and actually advocate it. Because, you're right, nobody would say wait three months to get your leg fixed, right, you know, if it was broken, nobody would say just tough it out for three months and then get seen. Well, that's exactly what's happening when we don't use telemedicine. When we have to wait three or four months to see a neurologist, everybody's like well, let's just wait and hope it gets better in between. If you thought about it like a broken leg, nobody would stand for that, nobody would do it. And yet that's exactly where we are here. So telemedicine has an opportunity to address that and fix it right.

0:15:37 - It's a chance to bridge the gap. You know that just people not having access, not having ability to get immediate consultation in and neurology is an area where that can be done with telemedicine. Different from you know somebody has a broken leg. You're going to have to get down there and fix that with your hands you know, to reset things to. What's the word fixation, you know, put it back in place, a reduction, like an open reduction, you know. But with a brain injury you can start to address things early on, you know, without having to be seen in person.

0:16:06 - I'm sure at some point in in-person appointment is going to be necessary, but I was going to say but a doctor could easily diagnose you and say well, while we're talking, I've noticed you're having some speech issues, let's get you into some speech therapy, right? They could, you know, while they're talking to them, say they noticed dizziness. Or they could say, step back from the camera and walk back to the wall, touch it and come back to see dizziness and things like that, and then they can diagnose or refer you out to get therapy for those areas, even though they haven't physically seen you in person, but they have seen you on screen and they can get you a lot of the necessary care. Or even my assumption is, if it was really badly at that, that neurologist could call a local hospital and say, hey, you need to see this person right away. They need to tell you to go to the ER right.

0:16:46 - Yeah, get a referral to the ER and, you know, maybe canceling out whatever I said about needing to be seen by neurologists at any point, but yeah, just getting, uh, getting to an ER or getting another referral that's immediate, saying hey look, this person needs immediate care. We've seen that happen. We've seen that happen through telemedicine. Someone be referred to. Go to the ER. Seek immediate attention for issues that they were in.

0:17:04 - And then the ER. I don't want to say saves their life, but all right, I will say saves their life. Yeah, that's your outcome. I've seen it on at least two cases where, but for going to the emergency room, things could have taken a very serious dark turn.

0:17:16 - Yeah, absolutely Absolutely. Uh, you know, we can have, yeah, all sorts of negative outcomes be averted and getting a specialist who's trained in this particular area, who's gone to school for this particular area, fellowships in this area, you know, versus an urgent care physician who you know. All credit to them for what they do. But you know, having one of those physicians diagnosed something versus someone who's trained to see it. Increasing quality of life is immeasurable.

0:17:41 - Patient outcomes and everything else. So anything else on telemedicine uh for for brain injuries and concussions uh you can think of right now Thomas.

0:17:52 - I think it's just an excellent option for people who don't have health insurance, uh, who don't have access to a neurologist in their county, and uh it's. It's going to be changing patient outcomes all across this country for foreseeable future.

0:18:06 - I was going to say, cause? You know, you quoted that statistic and I'll bring it up again Basically, 86% of counties don't have one neurologist and my guess is, if you took out the metro areas, it's probably closer to like 95%, I mean. So the statistic is actually, I feel like, a little bit wrong, because if you look at the metro areas, they're likely to have one Anywhere outside of. That is even worse.

0:18:25 - Yeah, Um the wasteland.

0:18:27 - It sounds like telemedicine or for driving two or three hours is probably the only option for a lot of our clients.

0:18:32 - Yeah, and it's not ideal in terms of not having an neurologist nearby. But what telemedicine does is it gives people options and it lets them choose, and all of those. We always want options and we always want to be able to choose. All right, and that's great.

0:18:45 - Well, Thomas, thanks for being on Mind Matters. And uh, once again, Thomas is one of the concussion and brain injury attorneys here at Shane Smith Law. For those listening, hit like and subscribe so you can get more updates on more podcast episodes from Mind Matters. Thanks a lot.

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