The author is A/Prof Stephen Reddel (Neurologist NSW). He is a member of the MAA Medical Advisory Board and we sincerely thank him for his guidance at this time.

G’day folks, hope you’re all safe and snug hunkered down at home in these times of isolation. COVID-19 has been pretty dreadful but so far Australia has done well and we hope that continues into the winter months where transmission of respiratory infections increases, so keep doing the right thing to help. Personally I’ve also got the COVIDSAFE infection tracking app and would recommend it to you and your family, you definitely want to know if anyone in your family has been exposed.  And while COVID-19 has been terribly disruptive we should always try to make the most of it, and hopefully use the opportunity to make things better.

I have been doing telemedicine for about 7 years, but until recently we have not been allowed to do this sanctioned by medicare other than for rural patients, so I have some ideas about what works and what doesn’t work. But this is a work in progress, so expect a learning curve. Do set this up with the doctor’s staff, and remember to update any personal details with them if required, and make sure there is a referral.

TECHNICAL STUFF

(this can be a bit daunting but almost everyone can make it work, so don’t give up):

Video is better than a call. We prefer to see people’s smiles, or not, and their droopy eyelids and anything else. So if possible use video, be it laptop, tablet, smartphone or relative’s smart phone. Remember a desktop computer generally has no camera unless specifically installed via USB. Check it all works with a test run to somebody else. Remember the doctor may be struggling with IT too, the hospitals can be particularly restrictive, and very occasionally the doctor could be a minute or two late. But at least by computer you can read my handwriting.

Methods vary by doctor, but include:

• where we connect by common server, such as Zoom, so you have to accept the invitation and click on a link to start. Do this a few minutes before the appointed time, so you can check everything works, and troubleshoot it with time if it doesn’t. You often need to touch the screen or wave the mouse pointer around to see the start video and start microphone settings. More than two people can login more readily, so this is good if a family member / carer would like to also join but is somewhere else, like sunbaking on Bondi beach (just joking).
• Device to device, by Skype or Whatsapp video call. Note facetime is Apple only, so we don’t tend to use that as a sole means. The quality is not quite as good but it’s a bit simpler. The doctor may prefer to use a dedicated skypename login for professional purposes for privacy. As Whatsapp uses the mobile phone number, again they would typically use a practice specific phone if using Whatsapp.
• Telephone call. When in doubt it works, so leave it on and readily available. I often find I have to call to explain a few technical things the first time, and the practice secretaries may also need to call.
• Email – check your email and have it on, instructions are usually via that means, and information can be sent out during the consultation if things are super-efficient.

MYASTHENIA STUFF

How’s it all going. Make some brief notes of things to discuss including how you are feeling, but remember this is not a social chat!

• Are there things that are due, or should be – like blood tests or bone density?
• What prescriptions do you need?
• Here’s the interesting bit – do your own myasthenia gravis composite (MGC) severity score modified for tele (secretly it uses some Quantative MG bits, but it is good enough). This is how we measure MG (including for eNID-MG). Do the following before the telemedicine
• Lie on your back. How long can you lift your leg off the bed at about 45 degrees  - try for 100sec. Record the time. If one hip (or shoulder below) is dodgy use the better one.
• Still on your back. How long can you lift your head off the bed at about 45 degrees – try  for 120sec. Record the time.
• Sitting now. How long can you hold your arms outstretched (90 degrees, but can be more forward or to the side). Try for 240sec and again record the time.
• Breathing, swallowing, chewing (chewy bread or steak) and talking  - are they normal, mildly not quite right, or more severely affected?
• Eyes can be checked by the doctor on video.

PRACTICAL STUFF

If you like to take someone along to an in-person consultation, do the same for telemedicine. Share the link if needed.

• Have there been any side effects of medications?
• Or any other serious things since last consultation, particularly infections, cancers including skin cancers, or operations?
• Or things that are going to happen, such as operations? Are you pregnant? Lads, if you ticked yes, this is going to get ugly.
• Any changes to your medications?
• What’s next, including next appointment, and in-person, telemedicine, or to be determined.
• Maybe use this as  a checklist, it could make things efficient

Stay safe – Stephen Reddel