As COVID-19 spread throughout the United States, more hospitals and doctors’ offices turned to telehealth as a way to stay connected with patients even when they couldn’t get to the office.
Telehealth, also known as telemedicine, comes in many varieties, but includes services offered through smartphone apps, remote monitoring of patients’ vital signs, and live video chats between a patient and doctor. Many doctors use video chats as a way to meet “face-to-face” with patients even when their patients can’t come into the office.
Dr. Khawar Siddique
, a neurospine surgeon at DOCS Spine + Orthopedics in Los Angeles, says the increased use of telehealth has been one of the positive things to come out of the COVID-19 crisis.
“At DOCS Spine + Orthopedics, we have been doing telehealth for months now and have found zero change in the quality of care,” he says. “In fact, many patients prefer not to drive into the office.”
However, he says there are times when an in-person visit is needed, such as when a person has weakness in the limbs, severe pain, worsening numbness, or loss of bladder or bowel control.
Many telehealth visits during the coronavirus pandemic have been for people who had an existing relationship with a doctor. But Dr. Nikhil R. Nayak
, a neurosurgeon with Virginia Neurosurgeons in Arlington, Virginia, has been using telehealth for both established and new patients.
“While the COVID-19 pandemic and the required safety precautions have necessitated telehealth visits, it has been a welcome addition to what we are able to offer patients,” he says.
The same technology that makes it easy for patients to virtually check in with their current doctor could also help people with back pain find a spine surgeon — without having to leave their house or apartment.
Telehealth could even make it easier for people to meet with spine surgeons from other parts of their state or the country, greatly expanding the pool of potential surgeons they can choose from.
Video Chats Offer Many Advantages
As with visits between doctors and their existing patients, not all aspects of a new patient visit can be done virtually, but some of it can. Nayak says when spine surgeons evaluate patients to see if surgery might be a good option for them, they consider three things — medical history, physical exam, and imaging.
“Two of those components can be thoroughly evaluated via telemedicine services — history and imaging,” he says.
A surgeon can easily collect a patient’s medical history during a video call. Many patients will also have had imaging scans done before they contact a surgeon. Doctors can often access a patient’s scans through the imaging center’s online portal, or the patient can mail them a CD with the images.
“Therefore, it is possible to determine which patients are likely ‘surgical’ or ‘non-surgical’ candidates,” says Nayak.
The initial telehealth meeting also gives patients a chance to do some “interviewing” of their own.
“Having a preliminary video meeting will often give patients a good sense of whether they feel comfortable with a surgeon prior to scheduling a subsequent in-person visit for the physical examination,” says Nayak. Finding a good fit with a surgeon can help build a trusting doctor-patient relationship, which is essential to the overall treatment plan, he adds.
Video calls between doctors and patients offer many advantages for the patient, even for people who are just “interviewing” potential spine surgeons.
“I have a lot of patients who travel hours to see me. With a phone consultation or follow-up appointment, it becomes much more convenient for those patients,” says Siddique. “Also, since DOCS is based in Los Angeles, many of our patients prefer to avoid traffic for an appointment that can be done via phone.”
Nayak agrees. “Patients have enjoyed not having to travel to the clinic, struggle with parking, or take excessive time away from work or other duties,” he says.
“In addition, telemedicine allows patients in areas of the country with less access to specialists to receive appropriate medical evaluations without excessive travel times,” he says.
Questions to Ask a Potential Spine Surgeon
If you are meeting with a spine surgeon for the first time over a video call, be prepared to ask a lot of questions. Here are a few to have at the ready. You may find the answers to some of these on the surgeon’s website.
What is the surgeon’s education and training?
“Like any other field — law, finance, or other professional services — there is a range in quality,” says Nayak, “and medicine is no exception.” So ask about the surgeon’s education and training. Are they board certified — or eligible to be board certified — in spine surgery? Have they completed a specialized fellowship program in spine surgery?
How much of the surgeon’s practice is devoted to the treatment of spine conditions?
Like every other skill, repetition builds expertise. Spinal surgery is no exception. “The focus of a surgeon's practice is also very important,” says Nayak, “as there are generalists who perform spine surgery, but spinal operations are not the majority of their case volume.” A spine surgeon who treats more patients will also likely be more familiar with newer technologies and techniques.
What are the potential complications of spinal surgery?
Before you have decided to undergo spinal surgery, you should ask questions about the risks and benefits of the procedure. This will help you decide if now is the best time to have the surgery. “Spinal surgery is major surgery with very real risks of unforeseen complications,” says Nayak. “A surgeon who is forthright will openly discuss these risks, as well as their personal experience with complications.”
Which surgical approaches and technologies does the surgeon recommend?
Spine surgeons use different surgical approaches to treat the same spine conditions, so if you talk to more than one surgeon, you may get different recommendations. Some methods may be more appropriate for your treatment, so you want to make sure you find a surgeon who can provide that option.
“It is important to ascertain what surgical options a spine surgeon is capable of offering, what their specific recommendation is for the patient's problem, and why,” says Nayak. “Ultimately, the surgeon needs to be comfortable with a specific approach to maximize the chance of success.”
Keep an eye out for warning signs
Most surgeons are fine with you asking lots of questions. They also understand that you may be talking to multiple surgeons. If you get push-back on these, the surgeon may not be a good fit.
“I have never met a surgeon who doesn’t say ‘I am the best!,’ says Siddique. “Ask for the real data: how many cases have they done, and what is their infection rate, hospital re-admission rate, and revision surgery rate. If they say that they don’t track that data, then find another surgeon.”
Telehealth provides a way for patients to connect with physicians through video calls, smartphone apps, and other methods. This is often used for people who have an existing relationship with a physician, but video calls can also provide a way for people who are considering having back surgery to speak with a spine surgeon without having to leave their home.
When you talk to a surgeon for the first time, whether it’s virtually or in person, have your questions ready in advance. This will help you choose a surgeon who is qualified to treat your condition, but is also a good fit for you. Having a good doctor-patient relationship is an important part of a successful treatment plan.
Updated: August 6, 2020