Dr. Evan Lewis did not need a global pandemic to appreciate the value of telemedicine.
The Toronto-based neurologist was already working “virtually” with epilepsy, migraine and head-injury patients as a way to dispense with current wait times of six to eight months to see a specialist.
Never mind adding insult to injury — In Lewis’ field, those lost months add injury to injury. With the virtual clinics, Dr. Lewis can see patients as soon as they are referred.
He has felt for some time that telemedicine is the future. He established the Neurology Centre of Toronto (NCT) in January 2017.
“I was trying to think of a way to roll this out. I knew patients would be on board. Doctors were another story. But COVID-19 kind of catalyzed it for physicians to see the value and to realize it’s is not as bad as they thought.”
One of the problems with wider acceptance of telemedicine, Lewis says, is the incorrect perception that it somehow replaces in person visits.
“It doesn’t replace in-person visits. It augments them. The metaphor I use is the long-distance relationship — nothing can replace your in-person relationship, but if your partner had to go to Europe to work for a year, or something like that, you would do everything you could to stay connected, from video conferencing to writing letters or sending packages. That would all support your relationship — but not replace it.”
Lewis trained as a paediatric neurologist at the Children’s Hospital of Eastern Ontario (CHEO) and completed fellowships in both clinical neurophysiology and epilepsy at Nicklaus Children’s Hospital (formerly known as Miami Children’s Hospital) and the Hospital for Sick Children.
As a neurologist, he also sees the psychological elements that can be part of the mix.
“There’s no separation between mind and body,” Lewis said.
That applies in particular to concussion patients. Concussion affects the neurological, “and everything else,” often leading to a whole host of symptoms.
He sees an alarming amount of concussions in the general public.
“And people don’t get proper care. The family doctor tells you to rest. After three weeks, you’re still not better. After three months, you can’t work, your emotions are disregulated … there are huge amounts of disability,” said Lewis. “Finally, someone wants you to see a concussion specialist. And the wait is six to eight months. That’s way too long.”
And so the idea for the clinics was born.
“They’re like walk-in clinics, only they’re virtual,” he added. “That was already 30% of my practise before the pandemic. COVID-19 has allowed us to innovate, to step forward. Instead of waiting months to see a specialist, you see your doctor, get a referral, check the available dates of our concussion clinic — they are once a week at a certain time — go through the online portal… and can be seen with no wait time.”
Lewis has four clinics. The epilepsy clinic has been a resounding success, especially important for the parents of infants who would otherwise have to wait months to consult a specialist.
So, it’s a serious blunder that Ontario has bungled payments to its doctors for virtual consults?
“It dissuades people from this model. This is really mixed messaging. Virtual care is a massive win for patients.”
And it’s becoming more popular everywhere.
“It’s a tool, it’s not a replacement. But there is a shift. The costs are covered by OHIP and there’s no wait for people with headache, concussion, epilepsy or other neurological disorders.
“Virtual is going to come to the forefront.”