Nurse practitioner Judy Greengold has about 1,500 patients on her panel at the Fulton practice of Johns Hopkins Community Physicians (JHCP). During the past 18 months, in addition to delivering routine care and managing acute visits through telemedicine, she says she has encountered “things that historically are evaluated and treated in the hospital.”

In particular, she recalls a Sept. 1 video visit with Sharon Graves, a patient who was worried she might be having a stroke. Reluctant to seek help at an emergency department, Graves asked Greengold about symptoms she hoped were caused by the extraordinary stress of her job: directing an intensive care unit (at Holy Cross Hospital in Silver Spring, Maryland) during a pandemic.

Graves recalls her symptoms this way: On Aug. 31, while dressing for work, she momentarily felt a “weird tingling” in her right arm, followed by a similar feeling on the right side of her tongue. Reassured by her blood pressure and otherwise good health, the 58-year-old nurse went to work.

That afternoon, however, she had the same feeling again. She went home, figuring she needed to rest.

The next day, Graves relayed her experience to Greengold in a video visit. Graves said that although she had considered the possibility that she was having a transient ischemic attack), or ministroke, she wrote it off as being due to a lot of pressure at work.

“As nurses, you can automatically think the worst thing, and then you dismiss it,” Graves says. “You rationalize it.”

As she listened, Greengold became concerned. She scheduled testing and imaging appointments for her patient within three hours of their video visit, and ordered medicine typically given to someone having a stroke.

The following morning, the neuroradiologist confirmed evidence of an acute stroke.

Greengold followed up with Graves immediately to explain the diagnosis and treatment plan, while JHCP staff coordinated her cardiology and neurology visits.

“Within the 24-hour period, we were able to find the stroke, give her the right medicine for it and get her full in-person evaluations with the respective specialists,” says Greengold, who was gratified to learn that the specialists’ physical examination notes were identical to what she noted during the video exam.

For her part, Graves was impressed that a telemedicine appointment could prove to be so accurate and that her treatment could proceed so quickly.

“Honestly, I wouldn’t have thought that before my own experience,” says the nurse of 36 years. Now back to work full time, she says she’s grateful for the convenience of being able to schedule follow-up video visits without having to leave her office.