Conducting a Telemedicine Neurologic Examination with Jennifer Robblee, MD
Jennifer Robblee, MD, shares best practices for a virtual headache visit
In the wake of the COVID-19 pandemic, headache practices have transitioned where possible to telemedicine. In this way, they can limit viral spread and protect patients, physicians and staff. However, not all aspects of a physical face-to-face neurologic exam readily translate to the virtual medium. To help healthcare practitioners have successful headache visits through video conferencing, AHS hosted a Facebook Live with Jennifer Robblee, MD. During the stream, she discussed how to conduct a telemedicine neurologic examination.
In the video, Dr. Robblee explains telemedicine techniques, gives advice on preparing patients for the appointment and explains how to modify common neurological exam techniques to fit the necessary limitations of telemedicine.
Preparing Patients for Their Telemedicine Visit
Dr. Robblee says that doctors should prepare their patients for the examination in advance. This includes listing any items that must be gathered before the appointment begins, such as a flashlight, ice cubes and a thermometer. Dr. Robblee highly recommends that a family member be present during the appointment to assist with some of the exam maneuvers. This is especially helpful if the patient has issues with mobility, dizziness or balance.
To follow best practices, she explains that practitioners should remove any distractions in the video background that might exacerbate symptoms in a patient with a headache disorder, like sun glare. Additionally, physicians should maintain eye contact by looking directly at the camera. If you need to check a patient’s health record, tell them why you are looking away so they know you are still attentive.
The Telemedicine Neurologic Exam
During the Facebook Live, Dr. Robblee walked viewers through a physical exam, including collecting vital signs like temperature, blood pressure and BMI. She also demonstrated assessing mental status and cranial nerves, and performing motor, sensory and coordination exams. “The good news is that a majority of our physical exam is a really reliable tool that we can do through telemedicine,” she said.
For example, it’s still possible to comment on mental status. Practitioners can do this by observing speech rate, volume and articulation, and assessing the patient’s thought process.