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Stories: Voices from the frontline

Yince Loh, M.D.

Even before the COVID-19 pandemic, Yince Loh, M.D., expected that telehealth would play a larger part in the future of health care. We caught up with the interventional neuroradiologist and neurointensivist to find out how the quicker-than-expected adoption virtual visits via Zoom has gone for his patients and what new possibilities are on the horizon for telehealth.

Why do patients come to see you?

I see patients for stroke and blood vessel problems of the brain and neck, like aneurysms and blood vessel malformation. Some patients have already had a stroke, and they need acute therapy or care in the neuro intensive care unit. But for the patients that I see in clinic, we’re trying to prevent a stroke before it happens. They might have an aneurysm or other issue found in imaging, caught during a screening because of their family history, or found because of symptoms like headaches, blurred vision and facial numbness. Those are the patients who can benefit from a virtual visit.

How have you adapted your in-person appointments to work with the virtual format?

Some of the things I can pick up during a virtual visit are facial weakness, arm weakness and coordination difficulties. A lot of my decision-making is based off of imaging and the patient’s clinical and family history. It involves going into how they found the problem: What were their symptoms before the problem? What had they been doing for their symptoms? Do other people in the family have similar problems, specifically for aneurysms? For arteriovenous malformations—or AVMs, in which veins and arteries in the brain are tangled up—we’ll ask patients if they’ve had symptoms that suggest they may have bled from the AVM. And then for patients that have carotid narrowing, we find out if the patient has had a stroke or transient ischemic attack, a temporary stroke that reverses on its own in less than an hour, and what kind of medications they are taking. It’s mostly history- and imaging-based decision-making.

How has the switch to virtual visits benefited patients?

I'd say about 50% of my patients are from outside of Seattle, so it's a useful tool that allows us to see patients from around the state and keep them from having to come in. We can cut it down to maybe one or two times that they actually need to come into Seattle and the hospital to have a procedure done. Coming into the city with traffic, it's usually an hour, hour and a half, for them to see me for about 15 to 20 minutes. And when I see patients virtually, they are clearly just happier people without all the hassles of getting to the clinic.

How has public opinion of telehealth changed since the start of the pandemic?

Before the pandemic, I think people in general had been thinking that telehealth was not as good as an in-person visit. But now after COVID-19 hit, people are more accepting of the fact that it’s going to be the norm. And I think they’ve realized, “I can get as much out of this as an in-person visit.” So there's really no downside.

What are some new technologies that telehealth will enable you to use?

One thing I’m excited about is the CorPath GRX system from Corindus, which includes a robotic arm that can be operated remotely to do neurovascular procedures, including thrombectomies—an emergency clot retrieval from a brain artery during a stroke. Eventually that will mean the robotic arm can be installed at one hospital while it is controlled by a physician using a console at another location. With about 15 physicians trained to do these types of procedure in the state, and more than half of them located in Seattle, this system could help patients get urgent procedures quicker, without needing to be transported to another city.

Some people have likened the impact of the thrombectomy on medicine to the invention of penicillin, but currently about one in every six patients that needs a thrombectomy can actually get one, because they’re not close enough to a regional center. It’s a public health issue in that we have a procedure that can significantly impact the lives and livelihoods of patients, yet not every hospital has someone who can do it. Our team would like to change that.

What’s the role of philanthropy in bringing leading-edge technology to Swedish?

Philanthropy really is the backbone of how we can bring in new technology like neuro-telerobotics. It helps Swedish to be at the tip of the spear, and to innovate. I think that the pioneers in medicine are almost always supported by a foundation, because they have a dream or a vision and somebody else has the ability to see that vision or get excited about it and help make it a reality.

Your support can bring leading-edge technology to our patients at the Swedish Neuroscience Institute. To learn more please contact Erika Nelsen at 206-386-6791 or erika.nelsen@swedish.org.