2.     The second situation that may draw you to hospitalization, or a hospital evaluation, is the so-called “elective admission.”  Many elective admissions relate to very serious problems, such as breathing difficulty, paralysis, speech or swallowing difficulties, or other inability to care for yourself at home. An elective admission may be arranged following a telephone contact with you, a clinical evaluation, direct communication with your other treating physicians, following a decision to transfer you to a local hospital from a distant facility, or a number of other different circumstances.

        When a decision has been made for an elective admission to the hospital for a neurology problem, you should be on the Absher Neurology service. If you are on Absher Neurology’s service, this means that you will see a physician from Absher Neurology every day that you are in the hospital. If your main problem is not a neurologic problem, you may be on some other physician’s service, and you may not see a neurologist every single day; in fact, your treating physician may decide that you do not require a consultation from Absher Neurology. You have the right to receive a consultation from Absher Neurology if you have any doubts about whether you need to have a neurologist provide input in your current situation. All you need to do is to specifically request a neurology consultation from your treating physician, who will then request a neurology consultation. We will come and evaluate the situation promptly. If there is a true emergency, we will drop everything and come to your assistance, depending on our judgment about the acuteness of your neurological needs.

        We have close relationships with internal medicine physicians and medical students. Often one of the medical students or internal medicine residents will have an opportunity to see you separately from your treating neurologist. If you are hospitalized at Greenville Memorial Hospital, you can expect a medical student and/or an internal medicine physician to see you in the morning prior to your evaluation by an Absher Neurology neurologist. These residents and medical students will perform careful assessments, and then present their findings to Dr. Absher, who will then evaluate you during “attending rounds.” Following attending rounds, these same physicians or medical students may be asked to carry out some of the work related to your ongoing care. For example, the medical student and internal medicine resident may perform a spinal fluid examination, if you permit them to do so.

        If you have any reservations about these other individuals performing a procedure or providing any of your health care needs, you certainly have the right to request that only the treating neurologist provides your neurological care. As the Director of Academic Neurology at the Greenville Hospital System, I specifically request that you permit the involvement of medical students and internal medicine physicians in your care, if possible. This is a valuable learning experience for them, and provides you with an opportunity for greater face to face contact with members of your treatment team. It is a win-win situation, with little to no "downside."

        Following your initial evaluation by Absher Neurology, you will receive appropriate diagnostic evaluation and treatment as demanded by the clinical situation. This may include a number of diagnostic tests and procedures, described elsewhere on this website.

        Your care will be coordinated among the treating physicians who are involved with your hospital-based care. At times, some of these other treating teams will play a more important role in your care than Absher Neurology. For example, I recently had a patient with a transient ischemic attack (TIA) who had an irregular heartbeat as the cause of these events. His cardiologist became the most important treating physician in his care. Absher Neurology made the appropriate referral, but then it was the cardiologist who placed the pacemaker and helped to eradicate the irregular heartbeat. This is just one example of how Absher Neurology will coordinate your care with your other physicians and help you to receive the best care possible while you are in the hospital.

        Our role as a consulting service is somewhat different. Your primary treating physician (the doctor who admitted you to the hospital) has the ultimate decision regarding the types of tests and treatment you receive. Disagreements between your treating physicians usually arise for good reason.  If there is ever any question about whether your neurology care is appropriate, you are encouraged to speak directly with Dr. Absher to make sure that your hospital-based care is on the right track.

        Part of your evaluation may be completed as an outpatient. Similarly, you may not need to stay in the hospital to receive your entire course of treatment. A perfect example is the situation that arises when someone presents to the hospital after a first-time seizure or convulsion. Often a few tests are done to make sure that a brain tumor, inflammation or infection, stroke, or some other serious problem is not present, and then a seizure medication may be administered to stop the convulsions. Once the seizures are brought under control, you may or may not require evaluation by a neurologist, and you may not require hospitalization. It may be perfectly appropriate to have you follow-up in our office for further management.

        No matter what type of tests or treatment you receive during your hospital stay, we at Absher Neurology want to make your hospital stay efficient, thorough and effective in addressing your neurological needs. Again, if there is any question about this, you should speak directly to Dr. Absher.

        There will come a time near the end of your hospital stay when we will need to talk about discharge planning. You will either need to go home with or without health care assistance or somewhere else. There are a variety of other options available to you besides simply returning to your own home. For example, you may have been admitted from or require discharge to a long-term care facility, such as an assisted living facility, a nursing home, a skilled nursing facility, a psychiatric facility, or a rehabilitation center. It is our goal to work with you to identify the most appropriate discharge plan, so that your health will rapidly return to its optimal state. A social worker, a rehabilitation specialist and your other treating physicians will assist you and your family in selecting a discharge option that works best. As in all aspects of your care, you have a choice in your disposition (where you go after your hospital stay has ended).

        You must realize, however, that your decisions may also have substantial financial costs. For example, if you fail to accept available nursing home placement, your insurance company may deny further payment for your hospital stay, after the date that they determine you were ready for discharge. This can lead to very high hospitalization costs to you. Usually it is better to accept placement in a facility that is not necessarily your first choice, and then transfer to another facility if necessary. We will make every effort to walk you through the pros and cons of your decision, usually with the help of a skilled social worker or case manager.

        In the event that you are unable or unwilling to participate in these decisions, we will need to seek guidance from other individuals as dictated by South Carolina law. You are encouraged to establish one individual as your health care power-of-attorney so that these decisions are likely to be in your best interest. If you have a stroke and become unable to communicate, such an individual will bear the primary responsibility for following your wishes. We will work with you and your significant others as well as your treatment team to come up with a plan for optimal neurology care following your discharge from the acute care setting.

OUTPATIENT SERVICES

    Absher Neurology prefers that you receive a consultation request from another treating physician in order to have an evaluation in our office, located at 274-A Commonwealth Drive, Greenville, South Carolina 29615. If you cannot receive a consultation request, then you may request an evaluation as a “self-referral”, which means that we understand that it is you who is requesting the evaluation. If a family member or friend suggests that you need to see a neurologist, and you contact us directly, this is still considered a self-referral even though someone else has suggested it. A self-referral simply means that there is no other physician who has specifically requested our services on your behalf. All new emergency "walk-in" patients (i.e., those patients never before seen by Absher Neurology who show up without an appointment) will be referred to the emergency room of the closest hospital following stabilization, as required by the Federal EMTALA guidelines.

    If you are an established patient, that is you already have been evaluated by Absher Neurology, you may be scheduled to return for a follow-up appointment. It is very important that you keep your appointments. Repeated failure to show up for your appointment, without calling us in a timely manner to reschedule for a later date, will result in your being “discharged” from Absher Neurology. We would rather continue to provide neurology services to you, but we must also respect the needs of other patients who have been waiting patiently for their appointments. If you fail to show up (or cancel an appointment without > 24 hours notice), you will be asked to find another neurologist. Our discharge policy is discussed in detail in a separate portion of this website, called Patient Responsibilities.

    If you are an established patient, you may call the office to request an "emergency work-in" appointment. As a rule, we operate under the philosophy that there is “always room for a work-in”. In reality, our threshold for making this determination is different from yours. We may perceive that the best place for you to receive an emergency evaluation is in the emergency room rather than in our office. We may decide that you can be seen safely within 1 to 3 weeks rather than being seen on the same day or the next day after your call. If at any time you question our judgment on this matter, you are strongly encouraged to bring your concerns to the attention of Dr. Pilch or Dr. Absher, or to go to the nearest emergency room for an evaluation.  It is difficult for us to know all of the facts about your emergency based on a telephone call.  Part of the responsibility for an emergency evaluation must be yours.

    Each time you come to Absher Neurology for an outpatient appointment, you will be asked to provide updated information on how to contact you and how to bill your insurance company. You may be asked to supply this information, and to pay any applicable “co-pay” when you first check in, before you are seen by the physician. There may be a need for you to complete paperwork. Your new patient evaluation requires about 20 to 30 minutes of paperwork, which you may complete on-line. If you bring the paperwork with you, you need not arrive early for your first new patient evaluation. If you have not completed your paperwork, we ask that you come 20 to 30 minutes early so that you may complete this paperwork and be available for your appointment at the scheduled time. Once you have become an established patient at Absher Neurology, you may be able to update your medication list, your medical records, your personal information, your treating physician information, and your insurance information by filling out the appropriate on-line forms. There is a separate section of our website that will be available only when you receive an Absher Neurology password that will take you to the appropriate section and all of the the forms that you may complete and submit on-line. After we gather all of the pertinent information, you will be called back to an examining room.

    You may receive both tests and procedures at Absher Neurology.  Some rooms are set up specifically for procedures, and others are set up for clinical evaluations. Usually, you will be asked to take off your shoes and socks. You may be asked to remove other pieces of clothing. Rarely will it be necessary for you to remove your undergarments. Usually a skilled neurologist can work around your bra or panties, but not pantyhose. You are asked not to wear pantyhose to your appointment if possible. If you get chilled waiting for your physician in the examining room in an examining gown, we have sheets and blankets available. For the extremely cold-blooded patient, we also have a portable room heater that can be made available.

    Often your first exposure to the Absher Neurology treatment team will be to one of our nurses or other staff. The nurses, Julie and Michelle, will verify your medication list and document other information in your chart. Your blood pressure, pulse, respiratory rate, and, in most cases, your weight will be recorded. Other pertinent health care information may also be requested, such as your past medical history, family history, social history, and review of systems. The details regarding these aspects of your history will be explained in another section of this website. When the clinical assistant is through with you, your chart will be placed on the wall rack and your doctor will be notified of your presence. Unfortunately, sometimes there is a significant time delay between your arrival in the office and the time when your doctor is able to begin your evaluation. We apologize in advance for any delays. It is our goal to see you within 30 minutes after the nurse places your chart in the chart rack.

    The next person you see may be a medical student, an internal medicine resident, the nurse practitioner, or one of the neurologists at Absher Neurology, Dr. Pilch or Dr. Absher. Sometimes two or more physicians, with or without medical students, may perform your initial physician evaluation. Some of the questions you were already asked, and the blood pressure and pulse determinations, may be repeated. This is a necessary part of your evaluation. You will then have a history, physical examination, review of any pertinent laboratory information, and other appropriate assessments. There are a large number of procedures and tests that we perform right in the office in order to make your experience efficient and to provide you with timely feedback on your tests. Once your evaluation has been completed, the medical student or internal medicine resident working with you will need to present the information to Dr. Pilch or to Dr. Absher. We will try our best to make sure that you see the same neurologist during each visit, although the medical students and residents will change every month, and some of your visits may be handled by the nurse practitioner. In this way, your continuity of care will be safeguarded when you are a patient of Absher Neurology.  If you prefer not to see the medical students, internal medicine residents, or nurse practitioner, this is your choice.  Simply notify the staff when you are called to confirm your appointment.

    The treating neurologist will again want to repeat certain aspects of the history, examination, and review of pertinent test results. You will then be informed of the interpretation and recommendations for further management. You will have ample opportunity to have your questions answered at the time of your evaluation. It seems as if patients always need more time than we are able to provide, and we find that this is a common situation at all physician offices. We would like nothing better than to be able to chat with you until each question has been answered. The reality is, instead, that we must expedite your assessment so that we can see the next patient who is waiting in the room next door. You are encouraged to bring a list of questions with you to your appointment so that we can make sure to address your needs in an efficient manner.

    At the completion of your visit, there are a number of specific steps you will be asked to take. First, you will be given a piece of paper, called the Super Bill. This contains information about specific codes used to classify your problems, and to charge you for Absher Neurology services. In addition, we will request specific tests and treatments on the bottom of this form. A follow-up appointment will be scheduled based on information provided on this form.

    You will take this form to the checkout window, where your tests and procedures will be scheduled as well as your follow-up appointment. If you are to receive sample medications, the nursing staff will provide these samples to you, answer your medication questions, and warn you of side effects. If you are supposed to receive any prescription medications, such as medication refills or new prescriptions, be sure that you have these with you when you go to the checkout window. You should receive an appointment card with the date and time of your next appointment. I suggest that you verify the date and time with the receptionist upon checkout, so that there is no mistake. Occasionally there has been mistake causing a patient to miss their scheduled appointment, or to show up at the wrong time. We do not want this to happen to you. On your way out, feel free to pick up any educational material we may have related to your specific tests, conditions or procedures. We have an abundance of pamphlets and other information available in the waiting area, examining rooms, and nursing station. Often, if you ask for information, we will have something to meet your needs. We have compiled a list of helpful resources on this website that you may also find worthwhile. We have a strong interest in teaching at Absher Neurology, and this applies not only to our medical students and internal medicine residents, but also to our patients, their families, and others. You will find a wealth of teaching material available on this website once you become an Absher Neurology patient.