Telehealth Best Practices: Dr Jonathan Fellows of Michigan Institute for Neurological Disorders On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Always ensure you have a secure network and a strong internet connection. Protecting your patients’ information and privacy is always paramount and nothing disrupts a patient visit more than freezing screens and choppy video.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Jonathan Fellows, DO.

Dr. Jonathan Fellows, DO is a Neurology Specialist in Farmington Hills, MI and has over 25 years of experience in the medical field. Dr. Fellows has more experience with Epilepsy, Neurodegenerative Disorders, and Headache than other specialists in his area. He graduated from Michigan State University College Of Osteopathic Medicine medical school in 1996. He is accepting new patients and has indicated that he accepts telehealth appointments. Be sure to call ahead with Dr. Fellows to book an appointment.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I grew up in a household that fostered my love of learning and I especially loved science. I was also taught to be compassionate and, as I got older, I came to realize any profession I selected would have to encompass my desire to help people in some way. I received my Bachelor of Arts degree from the University of Michigan and then moved on to the College of Osteopathic Medicine at Michigan State University. I began my medical studies focusing on internal medicine but, as I began to explore specialties, I became fascinated with the nervous system. It was interesting to learn that just a very small subset of the medical community has a firm grasp on it because of the level of specialization and this core knowledge.

Can you share the most interesting story that happened to you since you began your career?

Honestly, this a very difficult question to answer. Every day of practice writes a new or continuing story. I can think of one patient in particular that I care for. She’s a woman in her 50s who had a brain tumor diagnosed and treated surgically in her 30s. After the surgery, she developed seizures. I manage her medical treatment of epilepsy. I see her once or twice a year and, thankfully, since she continues to do well, we spend much of the visit talking about our children. We have children of similar ages and we bounce parenting ideas off each other. I have gotten to know her extremely well over the years and I truly look forward to our visit together. She is so inspiring because of her disease that she has fought and continues to win. To me, caring for patients with chronic illnesses who are winning their individual medical battles continue to inspire me and help me want to always try to improve myself.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“You can’t change people; you can only change how you respond to them.” This statement embodies our ability to control our emotions, to pause and assess situations and, overall, to maintain control of ourselves. The most powerful part of this statement is not about others, but about oneself — one’s ability to realize that they can make a difference by not being reactionary.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

I cannot attribute simply one person who guided me to success, but rather a group of people, including my parents, my wife and her parents. All of these individuals are or were incredibly hard-working people. It’s easy to become self-sufficient when you see others around you working hard and not depending on others for individual successes.

Advice ranged from “always do what makes you happy” to “find something you’re good at and go for it.” It may not always be the best advice to tell someone to follow a passion or simply do what makes you happy. I believe the best recipe for success is making a list of things you are good at, with examples being mathematics, problem solving, reading, carpentry and the list goes on and on. Start with the things you are good at and work hard to become great. There is a cost at becoming great at something, including things like time, money and dedication. Once you achieve greatness, more often than not happiness can sneak up right behind you.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

There is still no substitute for having a patient face to face. You are able to hear their history in person, see their emotions, read their full-body responses to questions and conversations and, most importantly, perform a face-to-face examination. Neurology is a field where the neurological exam is paramount. The phenomenon of structure and function — certain abnormalities of the nervous system yield varying neurological signs.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

It can be difficult to pick up on abnormal physical exam findings when you cannot check reflexes or perform a sensory exam.

There also are reimbursement concerns. It is easier to navigate payment and referral issues when a patient is face to face.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

5 things you need to know to care for your patients when they are not physically in front of you are:

1. Always ensure you have a secure network and a strong internet connection. Protecting your patients’ information and privacy is always paramount and nothing disrupts a patient visit more than freezing screens and choppy video. It makes it difficult for the doctor and the patient to focus and, as the signal goes in and out, you’re constantly restarting and trying to remember where you left off in your consultation.
2. Consider using two computers during telehealth visits. Use the first for your patient telehealth platform and leverage a second one for efficient electronic charting during the visit.
3. Establish a procedure for good follow-up with your staff after telehealth visits. In a telehealth situation, you, as the physician, could be in one place, your medical assistant could be another place and the patient in a third location. So, you must have a means to communicate with your staff for appropriate follow-up testing and for any necessary follow-up appointments.
4. Know your limitations. As a practitioner, do you want to evaluate new patients or are you going to limit to recheck patients or certain disease states? An example in neurology is a migraine, a wonderful diagnosis. A lot of what you do next is getting the migraine patient’s history and adjusting medications based on what they are telling you. In this case the physical examine is a little less critical.
5. Make and keep a very tight schedule with your telehealth patients. Patients will not wait as long in your virtual waiting room. They get there early to test their internet connection. You’ll have to be on time.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Although the neurological face to face physical exam is important, there is absolutely no substitute for obtaining a detailed history. I have been able to obtain detailed histories that help a great deal in making diagnoses or altering treatment plans.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

At the beginning of the pandemic, our team deployed Doxy.me as the platform to deliver telemedicine. There were certainly some growing pains, but the service sends the patient a link that they can use with their PC, laptop, tablet or smartphone. They do not need to download a specific app, which we felt was particularly important to minimize the learning curve. We have been overwhelmed by our patients’ ability to connect to the platform.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

The perfect telehealth system would be the creation of a universal platform that functions with all smartphones and all browsers would function perfectly to deliver seamless communication.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Because physicians are not able to do as detailed of a physical examination in order to help the patient, we want to be able to utilize that time to the best of both of our abilities and, therefore, get the most accurate history possible. Patients come prepared with everything they would normally bring to an in-person appointment. We still want to know your updated medication list, if you’ve taken your home blood pressure and what those numbers are, if you’ve seen any other doctors through any other diagnostic testing recently, your history or the current problem, or what’s new and what’s different.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Technology is rapidly evolving. I’m looking forward to being able to deliver medical technology across the globe via telecommunications that have zero lag. We’ll be able to perform diagnostic procedures and deliver care truly in real time across the globe. The amount of collaboration that will occur when physicians don’t need to be in the same room — or the same country, for that matter — will positively impact many patients.

Is there a part of this future vision that concerns you? Can you explain?

There is no substitute for the delivery of face-to-face medical care and we don’t want to make it too lax or too easy for patients to not come into our office. A telehealth evaluation is not the new normal. Especially in neurology, the physical examination is so paramount. We need updated physical exams and to be able to physically evaluate the patient using tools and technology that they simply aren’t able to have at home. Telehealth visits are not a permanent substitution for a face to face visit, but are wonderful adjuncts to traditional exams.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

In 2018, the New York University School of Medicine announced that it would cover the tuition for incoming and existing NYU medical school students, regardless of need, to help eliminate the financial debt that these students find themselves with upon graduation. Much of the funding needed was made possible by a $100 million contribution by Kenneth Langone for whom its medical school is named. This was on the heel of a $250 million gift from an alum received by Columbia for students facing the greatest needs to receive full tuition scholarships or grants instead of loans.

A movement that could take inspiration from NYU and Columbia’s case studies and jettison this philanthropic model nationwide would serve the greater good. The barrier to entry in the medical field would be dramatically lowered and this would open up the field to youth of limited means. The pressure to pursue a high paying sub-specialty would lessen and we’d expect to see more physicians going into areas. like general practice and pediatrics, which are greatly needed, too. Importantly, we’d evolve only the best and brightest individuals who want to commit their lives to medicine and would provide a greater opportunity for physician talent.

How can our readers further follow your work online?

Please follow me on social media at Facebook (https://www.facebook.com/MIND.physicians), Instagram at (https://www.instagram.com/mind_physicians) or LinkedIn (https://www.linkedin.com/company/michigan-institute-for-neurological-disorders-mind-/) ,as well as by visiting our website at https://mindonline.com.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.