NEURO

“It’s important to remember that the alternative to telehealth for many is not in-person care, it is no care because of barriers.” —Marla Kaufman, MD At the 2019 annual meeting of the American Association of Physical Medicine & Rehabilitation (AAPMR), the session on telemedicine was packed with physiatrists curious about how telemedicine can help them provide better and more efficient care for their patients. The session, conducted by physiatrists who serve as medical directors for telerehabilitation in the VA system, was titled, “TelePM&R: Lessons Learned and the Road Ahead.” Rebecca Tapia, MD, Associate Program Director, University of Texas Health Science Center SOM at San Antonio PM&R Program, opened the session emphasizing that seeing patients remotely offers advantages to both patient and physician, but it has to be used wisely. In fact, studies have shown that teleRehab offers a reduction in healthcare costs. Research also shows that patients are willing to try i

“How would you like patients to contact your practice?” asked Jeff Takacs in his session intro at the annual meeting of the Medical Group Management Association (MGMA) . “Your answer should be: However they prefer.” For many patients, that preference includes Facebook. Nearly 70 percent of all Americans are on Facebook, according to a 2018 survey by the Pew Research Center . Knowing this, many people in the medical practice management space are turning to this social network to engage with current and future patients. At this year’s MGMA meeting, Takacs, who is the Director of Content for MGMA, ran an interactive session on these very issues. “When prospective patients go to your Facebook page, take advantage of their familiarity with the app to get them scheduled,” he said. Session attendees agreed, with many reporting use of a dedicated person to continuously monitor their Facebook page. The cost of this in man hours as well as paid advertising seemed to be well worth it, consid

Referral development is in the top five must-haves, if you want to grow your practice . That is according to Phyllis Marino and Susan Boydell , two executive marketers who spoke at the recent annual meeting of the Medical Group Management Association . Referral development is about nurturing the referral sources you have and pursuing the ones you want. To do this, you need to meet their needs. Referral sources want two things from the physicians they refer to, says Boydell: “Take good care of my patient and make it easy for me to work with you.” The first part of that, taking good care of patients , is what you do. The second is where you may need some work and where healthcare marketing specialists like Marino and Boydell excel. “When a primary care physician refers a patient to a specialist,” says Boydell, that patient is their number one consideration. “We need to make sure that they feel good about that referral.” The best way for a specialist to make this happen is by commun

When someone looks for a new doctor these days, the first step they take is usually a quick Google search. Even if they ask for recommendations from friends or check online review sites, we all know that they will end up checking out the practice’s website before settling on a new physician. So beyond simply having a website, you need to be sure it provides visitors what they need. A few features can make the decision to book an appointment a whole lot easier. Is your website missing any of them? Obvious Navigation Nothing is more frustrating than searching and searching for the info you need on a website. So make sure your site visitors don’t feel that frustration—put your navigation menu in an obvious spot, preferably across the top. It’s also very important to make the menu labels very clear. It can be tempting to get creative with labeling, but no one wants to have to guess what a menu item means. For example, don’t give the page with information for new patients “Housekeepin

Between the need to see more and more patients and the increasing demands of paperwork, the idea of setting aside time to write educational information for patients or professional content for colleagues may seem ludicrous. Lack of time may truly be the biggest roadblock for the neurologist who wants to create digital content to help build their neurology practice. But in today’s online world, digital content is marketing currency. It can be shared on your website, and on social media channels to connect with potential patients and referring physicians. Marketing simply doesn’t happen without digital content any more. The good news is there is a secret you can use to help you create content without consuming too much of that precious time. That secret is repurposing content. Why Should You Repurpose Content? Even if you love creating all-new content, don’t overlook the treasure trove of existing material you can use and reuse. When you repurpose content, you are extending all of y

If you are like many Americans, you’ve already binged the first season of Tidying Up with Marie Kondo on Netflix and started decluttering your house. You might want to hold off, though, and skip straight to another, arguably greater, source of stress in your life: your office. This month on Instagram, Marie Kondo released a sneak peak of her forthcoming book, Joy at Work: Organizing Your Professional Life . Kondo has co-authored this book with Scott Sonenshein, a management professor at Rice University and author of Stretch: Unlock the Power of Less – and Achieve More Than You Ever Imagined . “As a business professor, I know too many emails, wasteful meetings and team conflict take the joy out of work.” Sonenshein told Forbes this month. “I’m excited to pair my research as an organizational psychologist with the KonMari method to give people the techniques, advice and inspiration to experience joy in all parts of their careers.” With some of the highest rates of burnout in the m

This summer more than 23,000 people crowded into New York City’s Arthur Ashe Stadium to watch their favorite Fortnite players compete to win $30 million in prize money. The players may have been wearing Nike apparel, but this was no ordinary sporting event. In fact, the only running that occurred was from offstage to individual computer terminals. There, players sat to competitively play Fortnite, a multiplayer video game that currently boasts more than 250 million players worldwide. Jose Posas, MD One of those players—though he was a little too busy with his day job to attend the championship in New York—is Jose Posas, MD, a neurologist at Ochsner Health System in New Orleans. As a long-time gamer, Posas likes to keep up with the latest gaming innovations. As a neurologist, he has a keen interest in how all this gaming affects the brain. Health professionals have long suspected that internet gaming in particular, has an effect on the brain’s reward center. In 2013, Internet G

For older adults with chronic low back pain (CLBP), functional impairment is often a way of life, and ineffective treatment is at the core of this problem. In order to change this too-frequent outcome so that quality of life can be maintained, we need new ways of managing patients with CLBP. A recent study, published in the journal Pain Medicine , looked at the impact of treating older patients in Aging Back Clinics (ABC) and compared those outcomes to those of patients who received usual care. The Aging Back Clinics approached CLBP in older adults as a geriatric syndrome rather than focusing exclusively on the spine. The study randomized 55 veterans, aged 60 to 89 with a diagnosis of low back pain. Twenty-five of the patients received ABC care and 30 received usual care. Patients were followed for six months, with the objective of testing the feasibility of caring for older adults in ABCs compared to the usual spine-focused care. The study assessed three primary outcomes: Curr

It’s not news to anyone that physical fitness has a positive effect on the health of pretty much every system in the body. But there are so many variables at play, it’s difficult to define the exact mechanism and magnitude of its effect on brain health. Are the brain benefits from fitness due to its effect on other issues such as blood pressure, blood glucose, or some other factor? Or does fitness have its own direct effects on the brain? And how fit is fit enough to yield benefits? A recent study examined these types of limitations in the existing data and attempted to fill in some blanks. The study, published in Nature , looked at the link between a variety of cognitive functions, brain structure, and fitness, and it did so while accounting for the confounding variables so prevalent in previous research. Researchers used the Human Connectome Project to gather their data. This project includes brain MRIs from over 1200 young adults. Participants underwent further testing includin

Dylan and his service dog Coffee. Image courtesy of 4 Paws for Ability. Is there a universal seizure odor? Karen Shirk, Executive Director of 4 Paws for Ability , is counting on it, and so are the kids and families her seizure-alert dogs match with. “We train our dogs with scent so they know the difference between what a person smells like that is going to have a seizure and what they smell like when they’re not. It’s a universal scent. We know this because we work our dogs with the scent from more than one person.” A very small study published earlier this year (2019) appears to back Shirk’s claim. The authors say they have found the first proof of a discernible odor signature associated with seizures. The study is small, just five trained dogs were studied. Nonetheless, the authors concluded, “This possibility was previously set aside because of the belief that epilepsy and seizure types were too individual-specific for a general cue to be found.” While not scent specific, ano

So much of the practice of neurology happens under the shadow of unanswered questions. One such unanswered question is how tightly to regulate blood glucose in the hours and days following acute ischemic stroke. We know that diabetes is associated with poorer outcomes after stroke , but how strict must we be with glucose control? A recent study provides some guidance by comparing the outcomes of more stringent glucose control to standard protocols after stroke. The results are a little surprising. The SHINE study , published in the July 23, 2019, issue of JAMA , enrolled 1,151 patients, with or without hyperglycemia, within 12 hours of acute ischemic stroke. Patients were randomly assigned to IV insulin with an aggressive target glucose of 80 to 130 mg/dL, or to the more standard sliding scale insulin with target glucose of 80 to 179 mg/dL for up to 72 hours. Patients were then evaluated after 90 days, with endpoints of disability, neurologic function, and quality of life considere

Our summer began with a slew of info we gathered from the annual meeting of the American Academy of Neurology. The neurologists that presented at that meeting were insightful and showed us what it is like to be on the front lines of neurology today. They spoke on issues surrounding the use of medical scribes, acupuncture, teleneurology, and much more. We picked five of our best posts from this summer season. Read on to find out if one of these posts can give you the insight you need as a neurologist practicing today. POST #1 Social Relationships and Health Outcomes: The Role of Neurology Harvard neurologist, Dr. Joel Salinas, MD, researches social isolation and its effect on health outcomes. Evidence continues to mount regarding the significance of this impact. Among other things, social isolation is associated with an increased risk of stroke and dementia. Learn more about social relationships and health outcomes, and the role of neurology . POST #2 Does Adding Acupuncture to

As widespread awareness of the significance of dementia continues to grow, more and more patients want to know how they can prevent it. A recent study uncovered a potential opportunity for younger patients to decrease their risk for dementia later in life: keep blood pressure within normal bounds and avoid large increases, even within those normal bounds. The study, conducted by Christopher A. Lane, PhD, and colleagues at the University College of London, was published in Lancet Neurology on August 20, 2019. It showed that early middle age may be a time of particular vulnerability to both high and rising blood pressure. The longitudinal study followed a cohort of individuals born in the UK in 1946. Those who had higher pressures or larger increases in blood pressure between ages 36 and 53 also had more white matter lesions and smaller brain volume later in life. Specifically, a 10 mmHg increase in systolic BP from age 43 to 53 showed 7 percent more white matter lesions, while a 1

“Dear Dr._____, Well Done! From the most trusted resource in healthcare, ______ is honored to announce your selection as a 2019 Top Doctor. Be sure to put your 2019 award prominently on display. It’s sure to impress.” This is how it starts, and it seems pretty straightforward: You, a physician, get a letter like the one above saying you’ve been named a “Top Doctor” or “Best Doctor” or “Super Doctor” or the like. All you have to do is pay the sender for a plaque to hang on your wall and a listing in their top doctor guidebook. Nothing more to it, and you get instant respectability and your practice grows. Based on the amount of top doctor boasting that goes on across the internet and on office walls, the formula has wide appeal and patients really are impressed. Yet, maybe you don’t feel as incredibly proud of this award as the letter preceding it suggests you should. Why is that? Perhaps you have some perspective on these kinds of awards that patients don’t. For example, you know

How to make physicians roll their eyes: Talk to them about online physician-rating sites. According to this 2019 study evaluating two of these of sites , Healthgrades.com and Vitals.com, only about 25 percent of physicians even check their scores on these websites. And almost none of those who do check them make changes based on those reviews. The arguments against these sites (and the cause of some eye rolling) include lack of score validity and the disgruntled-patient factor. “Disgruntled or frustrated patients may give undeserving bad reviews based on a single experience that could then discourage other patients from seeking care from that particular physician,” say the authors. Fortunately, of the small number of patients (seven percent) who actually leave reviews, even fewer leave bad reviews, let alone scathing reviews. In fact, most reviews are positive, with an average rating of eight out of ten. Unfortunately, one bad review in a small pool of reviews can be disproporti

There are few prognoses that carry as much weight as the one made for a patient with a disorder of consciousness (DoC). Erring one way could mean a life ends while there is still the possibility of improvement. Erring in the other direction could mean prolonging a life with no meaningful recovery. This is why the American Academy of Neurology updated their practice guidelines for disorders of consciousness in 2018 to address these issues. The new guidelines can be divided into four broad areas of care: overall care and diagnosis for adults with a prolonged DoC prognosis for adults with a prolonged DoC care and treatment for adults with a prolonged DoC care for children with a prolonged DoC The guidelines cover topics from referring medically-stable patients to appropriate facilities to increasing patient-arousal level prior to diagnostic testing (and which tests to use). Of particular note is Recommendation 3 : When discussing prognosis with caregivers of patients with DoC