Introduction

This portion of our website will describe in some detail what you can expect from Absher Neurology as your neurology health care provider. We describe inpatient and outpatient experiences, tests and procedures, and general strategies for the evaluation and treatment of specific disorders and conditions. We summarize key aspects of common neurologic conditions, offer a Patient Library with an extensive collection of useful disease-related information, and provide links to other sources of information. Additional material may also be added. Contact us with your feedback. We appreciate your involvement in Absher Neurology’s quest for continuous quality improvement.

Being “inpatient” means that you are in a hospital or other medical facility, in an emergency room, hospital room, intensive care unit, or other assessment area. When you are so ill that you cannot even stay at your own home, it is a scary and dangerous time. Here is what you can expect from Absher Neurology when you are inpatient:

  1. We will do our best to identify situations that might require inpatient evaluation and treatment. For example, if you call us and describe new stroke symptoms, we may advise you to call 911 or go straight to the closest hospital. If any of the problems described over the phone or during an appointment seem to require a trip to the hospital, we will encourage you to go. For many neurological emergencies, the sooner you can get to the emergency room, the better outcome you will have. Although we will try our best to identify situations that require inpatient or emergency evaluation, you should not hesitate to call 911 and go straight to the emergency room when you believe there is a serious risk to your health. Do not wait for Absher Neurology or any other doctors in an emergency, just call 911.
  1. If your trip to the hospital is due to a neurologic problem, please notify Absher Neurology or ask someone else to let us know that you are on the way to the hospital. You may arrive at a hospital Emergency Department (ED) with the help of a stranger, family member, friend, or Emergency Medical Service (EMS). Hospital staff are usually willing to contact us, if you tell them you are an Absher Neurology patient, especially if a neurology consultation is needed. If you require immediate attention, such as treatment of uncontrolled seizures or acute stroke, the “on-call” neurologist will assess you right away. Absher Neurology provides on-call services periodically to both the Greenville Health System and St. Francis Bon Secours Health System. Even if Absher Neurology is not on call, you may ask your treating physician to have us perform a neurology consultation, if you think that your problem is related to any ongoing neurological issue, or if you believe that you have developed a new neurological problem. When you are an Absher Neurology patient, we can be involved in your inpatient neurology care as either the main (attending) physician overseeing your care, or as consultant.
  1. Another situation that may lead to hospitalization is an “elective admission.” 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 as a result of a number of other circumstances. Absher Neurology can arrange for you to be admitted on an elective basis (that is, scheduled in advance) for inpatient evaluations such as a prolonged video EEG, treatment of refractory migraines, or baclofen pump
  1. Typically, if you have an elective admission to the hospital for a neurologic problem, you should be on the Absher Neurology service. However, there may be situations when this is not possible, such as if you are admitted to a specialized facility. For example, a dementia syndrome that gets out of control may require psychiatric hospitalization; a muscle disease may progress to the stage that inpatient rehabilitation is needed; complicated strokes such as brain hemorrhage may require prolonged recovery in a long-term care facility, or long-term acute care (LTAC) facility. If we arrange your elective admission to our service, then Absher Neurology will see you every single day while you are in the hospital.
  1. If you are on the Absher Neurology service, your overall care will be coordinated by Absher Neurology, and Absher Neurology will see you every single day while you are in the hospital. At times, other treating physicians/teams will play a more important role in your care than Absher Neurology. For example, I recently had a patient with stroke due to an irregular heartbeat. His cardiologist became the most important treating physician in his care. In another case, a patient with myasthenia gravis required plasma exchange, a treatment handled by the blood doctors (hematologists) that we consulted to provide this service. These are just two examples of how Absher Neurology coordinates care with other physicians and health care professionals, so you receive the best care possible while you are in the hospital.
  1. When you are on another inpatient service, and Absher Neurology serves as consultant, we can help guide and coordinate your overall neurological care during your hospitalization. The “attending” physician (the doctor who admitted you to the hospital) has the greatest influence on the types of tests and treatments you receive. 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.
  1. Absher Neurology can help you get out of the hospital as quickly as possible by coordinating those aspects of your evaluation or treatment that may be completed as an outpatient. Quite often, you do not need to stay in the hospital to receive your entire course of evaluation or 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. 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 outpatient tests and treatments, and then follow-up in the Absher Neurology office.
  1. There are a variety of other options available to you besides simply returning to your own home, and Absher Neurology can help you make the best decision about the “next steps” following hospitalization. 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). Absher Neurology can make sure you have the information you need to make the best choices about these next steps, and also can arrange for you to meet with professionals equipped to provide this information.
  1. 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 determined you were ready for discharge. This can lead to very high hospitalization costs to you. Absher Neurology will make every effort to explain the financial pros and cons of your decisions, often with the help of a social worker or case manager.
  1. In the event that you are unable or unwilling to participate in health care decisions, Absher Neurology will seek guidance from other individuals as dictated by South Carolina law. You are encouraged to establish one trusted individual (usually a close relative or friend) as your health care power-of-attorney (HCPOA) so that all health care decisions are likely to be in your best interest. If you become unable to communicate, your HCPOA will bear the primary responsibility for following your wishes. We will work with you whenever possible, and when this is not possible we will work with your significant others, HCPOA, and other members of your treatment team to make the best decisions regarding your neurologic care.

Absher Neurology prefers that you receive a consultation request from another treating physician in order to have an evaluation in our office, located at 155-B Halton Village Circle, Greenville, South Carolina 29607. 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. 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. 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 involve office staff. They 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 nurse practitioner, or the neurologist, Dr. Absher. 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.

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 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.