Research in a hospital setting
Digital Doctor: Technology in epilepsy clinics

Professor Markus Reuber
Innovations in Healthcare Research Awardee
University of Sheffield

On the Research Blog today we speak to Professor Markus Reuber, who was awarded an Innovations in Healthcare Research Award for his project which will help improve the effectiveness of remote ‘teleconsultations’ between patients and neurologists.

It’s November 2019, and a woman with epilepsy has arrived at the hospital for a consultation with her neurologist. She had managed to persuade a friend to drop her off at the hospital because she can’t drive and buses only run infrequently where she lives. Having spent some time in a busy waiting room alongside other patients (none of whom are wearing face masks), she is called into her appointment. The consultation goes as expected: the neurologist asks questions, conducts an examination and makes recommendations. Before she leaves, the patient shakes the neurologist’s hand.

12 months later, COVID-19 has made this once-unremarkable scenario an unrealistic fantasy; like all aspects of society, the way in which medical professionals and patients talk to each other has changed. Neurologists and patients still speak to each other, of course, but instead of encounters happening in person, most such meetings are taking place over the telephone or via the internet.

Such ‘teleconsultations’, as they’re called, are not new. But the rate and scale at which patients and neurologists have adopted them because of the pandemic is unprecedented, and as with any rapid change, there are potential problems. First and most obviously, meeting a patient remotely means that the neurologist cannot physically examine them. But many other communication channels that we normally use to ensure that we understand one another – from facial expressions to gestures or action are also disrupted. Video calls allow for some visual information, but still, limit our means of communication. There is also evidence that teleconsultations tend to be shorter than in-person consultations, suggesting that they are ‘missing’ something.

Right now we do not know what the missing bits are. In fact, even though it is now the norm, we don’t know much at all about ‘teleneurology’—we don’t even know what we don’t know!

This is why we intend to conduct the first research on teleneurology consultations as they occur in practice. This will mean recording at least 30 remote consultations between neurologists and patients with epilepsy, as well as conducting interviews with the participants. We will then compare these consultations with an existing collection of 50 previously recorded in-person consultations from the same epilepsy service. This will reveal how and why remote and in-person consultations differ from each other and allow us to make recommendations to neurologists about how they can better communicate with patients when they are not in the same room as them.

However, this research is not simply about helping patients and neurologists make do until things go back to normal. For one thing, we don’t know if things ever will go back to normal, at least in the sense that we understood it before COVID-19. And it would be wrong to treat teleconsultations as if they are nothing more than an imperfect stopgap solution; for all their limitations, they do also have advantages over in-person consultations. Consider, for example, the patient imagined above, who lives in the country and cannot drive. What would have been a three or four hour round trip for this patient becomes, with a teleconsultation, a 20-minute phone or video call.

If this kind of convenience can, as we hope, be combined with effective, evidence-based, and safe communication practices, we believe that teleconsultations can become an important part of neurological practice in the long term.

-Professor Markus Reuber

Read more about Professor Markus Reuber’s project ‘Comparing Interactions In Remote And Face-To-Face Seizure Clinic Consultations’ here.

Markus spoke at our recent ‘Shape Network Live’ conference, held at The Francis Crick Institute. The conference was recorded and we are delighted to make the screening of the ‘research in a hopsital setting’ talk available this week. The session is open to everyone and will be held at 11am on Thursday 30th June. Register for free here.


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