ABC Gippsland featured Telecare Neurologist Dr Michael Zhong

11 February, 2023

East Gippsland resident David Harlem had hardly needed a sick day in his life until he experienced symptoms indicating he was at risk of having a stroke.

Key points:

  • A Paynesville resident was experiencing precursors to a stroke and was referred to a neurologist over telehealth
  • The nearest neurologist was located more than 150 kilometres away and had a weeks-long waiting list
  • Rural Doctors Association of Victoria says more funding needs to be dedicated to specialist telehealth consultations

The 73-year-old saw his GP after suffering altitudinal visual field defects, causing periods of blindness in his right eye.

"I was presented with symptoms that put me in a time-critical situation as a ticking time bomb," Mr Harlem said.

"That was confronting in as much as I'd never been sick in my life before and confronting because I realised that I needed specialist treatment."

The closest neurologist to Mr Harlem's rural town of Paynesville was more than 150 kilometres away with a months-long waiting list, therefore his GP referred him to a specialist whom he consulted with via telehealth within a few days.

Mr Harlem said the process of being connected to a specialist by his GP quickly was "astounding".

"That just highlights to me the absolute necessity of telemedicine for the population," he said.

A 'harbinger' of stroke

Alfred Hospital and telecare neurologist Michael Zhong requested multiples tests for Mr Harlem to complete locally at Bairnsdale Hospital and later diagnosed him with carotid artery stenosis, a condition where the blood vessels carrying blood from the heart to the brain are narrowed.

Michael Zhong - neurologist
Michael Zhong says the main benefit of telehealth is the ability to see patients quite quickly.(Supplied: Michael Zhong)

"We know [these symptoms] to be a bit of a harbinger of potentially quite debilitating stroke, a major stroke," he said.

"He showed that he had greater than 80 per cent narrowing of the carotid artery,"

"That is a risky situation to be in and in the right circumstances should be operated on."

Within days, Dr Zhong had organised for Mr Harlem to be admitted to a metropolitan hospital's stroke unit, where he was considered for surgery.

"By the time he was admitted to hospital it was very timely and probably better than what I could have done in person even," he said.

Telehealth is vital

Dr Zhong said telehealth was especially important for people living regionally, as vital tests could be performed more quickly, especially in cases that would not require a visual examination.

"His story is one of those that you hear about, rather see or examine any abnormalities," he said.

"It's definitely situation-dependent ... what I often end up doing is providing a provisional plan because our waitlist is much shorter than in-person specialists regionally.

"I arrange some tests to begin with, that they would have had done anyway if they waited a year."

These services were covered by the Medicare Benefits Schedule for rural patients during the pandemic, but funding has since been changed to exclude most specialist telehealth consultations.

Rural Doctor's Association Victoria's Rob Phair said these services should be bulk-billed for people living in rural Victoria.

"From an equity point of view, we really think that these services should be provided at no cost, and most certainly for disadvantaged patients," he said.

Remote care challenges

Dr Phair said although telehealth was good for organising local scans quickly, it did present some challenges for doctors and patients.

"Telehealth potentially means you've got a whole lot more providers around; it's a bit of an unregulated space," he said.

"You've got a whole lot of players and the communication is not always great ... and you have a lot of potential for fragmentation of care."

Dr Phair says rural patients are unfairly disadvantaged with many publicly funded hospitals around Melbourne providing very high standards of care that are unavailable regionally.

A man stands in a hospital corridor wearing doctor's scrubs, a stethoscope, glasses and a face mask
Rob Phair says regional healthcare providers are limited in the care they can provide.(Supplied)

"Regardless of your income, you can access very high standards of care, so it's not fair or equitable for rural patients to have to pay not only for the cost of travel and accommodation but even for the cost of seeing as certain type of health professional," he said.

"Some of our older, frail patients who may have issues with hearing may need a really clear explanation and may also have lower health literacy so we need to really take our time and the face-to-face part is really important."