With many of the conditions I treat, anxiety is a huge factor. Virtual care allows us to chat in a place they’re most comfortable.
The New House Call
Halifax neurologist Dr. Kerrie Schoffer has built a career around providing care to Nova Scotians who live with neurodegenerative conditions like Parkinson’s and Huntington’s disease.
“I’ve found myself in an area of medicine that sees challenging conditions that people live with for a long time, which progress and become more difficult over time,” she says.
“Patients are my greatest motivation. It’s inspiring to see people rise to the challenges these diseases present and humbling to have families trust you to guide them through difficult times.”
Born and raised in Saskatchewan, Dr. Schoffer came to Dalhousie for residency training, and returned in 2007, following fellowships in movement disorders in Brisbane and Melbourne, Australia. “I was interested in how much was still unknown in this particular area – it was a growing subspecialty with great potential for new treatments,” she says.
She says it’s encouraging to see the field expand and offer more support and treatment options for patients. “Back when I was in medical school, neurology was thought of as an academic speciality, but it has grown with interventional treatments and cutting-edge research developments.”
Dr. Schoffer returned to provide care at the QEII Health Sciences Centre and at her own clinic in Halifax. As an assistant professor at Dalhousie, she also teaches medical students and residents.
In 2007, she established Halifax’s first clinic at the Halifax Infirmary devoted to movement disorders, treating people who have conditions like dystonia, ataxia, Tourette syndrome and Parkinson’s.
In addition to the movement disorders clinic, she formed a team with neurologists, nurses, a psychiatrist and a social worker and developed a dedicated clinic to help patients with Huntington’s disease. A genetic condition that affects people of all ages, including children, the disease causes problems with movement, mood and cognition. “It’s a very challenging condition, because it affects many different aspects of people’s health,” she says.
In 2019, Dr. Schoffer collaborated with the QEII Health Sciences Centre and True North Clinical Research to bring research trials involving movement disorders to Atlantic Canada. “It’s been tremendous to see the growth and see Halifax show up as a research trial site on worldwide platforms. It’s rewarding to be able to offer these opportunities to our patients.”
When COVID-19 hit, she had to change how she offered patient care. During lockdown, she began offering virtual visits. “It was a learning experience for everyone,” she recalls. “In the beginning, a lot of our patients found the technology challenging. But as time went on, they became more confident with their computer skills.”
She soon started seeing what virtual visits could add to her practice. For patients who deal with mobility issues or live in remote areas, care was suddenly more accessible. “Virtual care brought people to a more even level of care throughout our province,” says Dr. Schoffer.
She says it helps strengthen the patient-doctor relationship. “I often get to meet their whole family and gain much more of an understanding of the patient as a whole than I would get with an office appointment. For my patients who live alone, it’s a chance to see their home life and how they are coping.”
In many ways, virtual care has become the new house call for Dr. Schoffer, giving her a closer, more personal view of the issues that her patients face and the level of support they have at home. “With a virtual appointment, I can see into my patient’s home. I can tour their house and point out things like fall hazards while we’re chatting.”
Patients are also more ease in their own home than in a doctor’s office. “With many of the conditions I treat, anxiety is a huge factor. Virtual care allows us to chat in a place they’re most comfortable.”
Dr. Schoffer has found people rarely miss virtual appointments. “If they’re not feeling well that day, they can usually still attend, whereas if the appointment was in person, they would have to cancel.”
She says her patients like knowing they have options when it comes to virtual care. “There’s not a one-size-fits-all approach for all patients. Every patient and every visit is different, and some do prefer or need face-to-face [visits].”
Dr. Schoffer would like to see virtual care fee codes start covering asynchronous care – that is, secure messaging such as emailing and texting between patients and providers – which is not currently covered. “With neurodegenerative diseases, patients often need to make adjustments to their medications between visits,” she says. “Secure messaging allows us to communicate efficiently between in-person visits. It’s also helpful for patients with memory issues because they can refer back to the written comments provided.”
Neurology is very much an observational specialty. With movement disorders, observing the bothersome movement is key to making a correct diagnosis. “Movements don’t always happen in the office,” says Dr. Schoffer. “With asynchronous care, patients can use their cell phone to record their movement when it occurs at home, and securely email us a video so we can assess it.”
“Asynchronous care also allows me to respond to emails and queries from patients in the evening, or when I have time,” adds Dr. Schoffer, who is a busy parent of three children when she’s not practising medicine.
She’d also like to see physician-to-physician virtual and asynchronous consultations compensated, so that family physicians and specialists can connect over email, video or phone to discuss their mutual patient’s management decisions. “Being able to communicate physician to physician makes health-care management a team approach and is so much smoother and efficient for our patients.”
Looking ahead, Dr. Schoffer says she’s excited to see how technology evolves to improve patient care. Through her research program, she’s already been testing smartphone apps to remotely track and analyze data for patients who are experiencing tremors and chorea. “I can’t wait to see where the technology takes us. It could be a very different practice in 10 years.”