Meet Scott Mendelson, M.D., Vice Chief of Neurology at Access TeleCare
Scott Mendelson, M.D., vice chief of neurology at Access TeleCare, has spent much of his career exploring how teleNeurology can bring timely specialty expertise directly to patients and hospital teams.
A stroke neurologist with extensive experience developing and improving telehealth programs, Dr. Mendelson recently joined Access TeleCare Regional Medical Director, Viren Patel for a conversation about his path into neurology, the value of virtual care, and the advice that continues to guide his career.
Like many of today’s specialists, exposure to telemedicine and best practices is more frequent during residency and fellowship training. Rather than taking on the practice as an add-on, telemedicine is more often an integrated function of great patient care. Mendelson was first exposed to teleStroke during a vascular neurology fellowship, when the hospital where he trained operated an established network providing emergency neurological care to partner hospitals. He quickly learned that practicing through telehealth required its own set of technical and clinical skills.
What initially drew you to neurology?
In medical school, I was part of an M.D.-Ph.D. program, and I did my graduate work in the neurosciences. I was very much motivated by how neurotransmitters affect behavior and how different complex behaviors grow out from basic neuronal networks.
When I got to the bedside with neurology and was dealing with the complex patients that neurologists often have to deal with, learning and applying my knowledge of neuroanatomy, dealing with critical illness in neurology, as well as the difficult decision-making in neurology, it really drew me to that clinical practice and that bedside.
Ultimately, it wasn’t a hard choice to pursue neurology as a career and a life passion.
What surprised you most once you began practicing neurology?
One of the things that really engages me about neurology is the challenging questions. A lot of what we deal with in neurology is not just life extension or quantity of care, but really quality-of-care decisions. It requires an understanding not only of prognostication — being able to predict the future in a lot of ways for patients and families—but then understanding, for the patient, what the future means for them.
Those conversations require neurologists to consider a patient’s medical condition alongside the goals and expectations of the patient and their family.
What are the goals that they have? What are the aspirations that their families have? You’re weighing your clinical knowledge, and sometimes the limited ability to prognosticate what a particular individual is going to experience and marrying that with what that individual’s desires are or would have been, or their family’s expectations.
That degree of nuance, empathy, and care really motivates me to do what we do, and it was completely unanticipated.
How did you get started in telemedicine?
I saw my mentors and my attendings participating in (teleStroke during a vascular neurology fellowship), and I learned the logistics behind it. Then, when I had an opportunity to join that same group as faculty, I was thrown into that same mix of covering their telestroke network.
I went through the usual acclimation process — trying to figure out how to operate cameras, how to log into electronic health records remotely, how to coax a neurological exam from trainees or clinicians remotely, and how to really assess a patient via telehealth.
How did you take away from how telemedicine can affect quality?
I really dove into that process. I loved learning about the nuances of workflows and process improvement, and ultimately, we had a really good outcome.
What are the steps necessary to evaluate those patients quickly, get them the therapies they can receive on-site quickly, and then move them to their next destination for their ultimate level of care?
The initiative reduced transfer times and demonstrated how a coordinated teleNeurology program could directly affect patient care.
I really saw the effect a well-streamlined teleNeurology program can have directly on patient care.
What is your favorite part of being a teleNeurologist?
There are not enough neurologists to go around. Neurologists are few and far between. That level of expertise is concentrated in individuals. The patients, though, show up everywhere. The patients are all throughout the country.
To be able to leverage technology to lay bare our expertise where the patients are, where it’s needed most, in an efficient, on-demand manner — I think that is the strength and the real opportunity with telehealth.
What advice would you give a clinician who is interested in telemedicine?
Try it. Avail yourself of opportunities, wherever they may be, to get exposure to it.
You’ll learn a lot about the nuances that might differ from some inpatient encounters, but also about the similarities — how you’re able to achieve accurate history-taking and how you’re able to glean enough of an exam to make a diagnosis or help manage care.
My hunch is that, if you get exposed to it, you’re going to like it.
What are the biggest challenges facing healthcare and telemedicine?
The resources are constrained. There’s a resource-constraint problem, and there’s a coordination problem that I think telehealth can bridge, which is bringing the experts to where the patient is, as opposed to the current model of care, which is moving patients wherever that individual or coordinated care system may be.
While some procedures and complex treatments will always require patients to travel, many neurological evaluations can be provided virtually.
For a lot of things that don’t actually require in-person interaction between that expert — in this case, the neurologist — and that patient, we can really leverage those resources and expand them out.
We’re not where we need to be. There are too many patients to move all of them to centers of excellence, hospitals, and venues where the neurologists are. Rather, let’s push that care out to where the patients are via telehealth.
Acceptance remains another challenge, although comfort with video-based communication has grown.
People are much more comfortable now interacting via video than they were before. But there are still perceptions and behaviors that need to be overcome when administering important, lifesaving therapeutic care via telehealth.
My expectation is that, with time, it will become more commonplace and more accepted.
What is the best advice you have received from a mentor?
Sample, sample, sample.
When you’re trying to study something or understand something, you want as much data around the experience as you can.
When you’re in medical school and moving from clerkship to clerkship, that’s a sample, sample, sample process. You’re getting exposed to different styles of medicine. You’re getting exposed to different questions and different problems. What is it that speaks to you?
That was the sampling process that led me to neurology. The same approach continues to influence how he evaluates patients, makes decisions, and approaches life.
You want to get multiple data points over multiple periods of time to understand what those things are. It’s a mantra that has served me well.
