Virtual Dermatology Appointments
Can you briefly explain what a virtual dermatologist appointment consists of?
Teledermatology has been a hot topic for years as it seems so logical for dermatologists, a visual field to strongly consider the application of this technology to their practices. Essentially the practice is one where a virtual visit with a dermatologist is made in one of a few ways.
One method offered by many practices involves the use of their own electronic records to see established patients of the practice virtually for various skin conditions. In my practice we often utilize this for acne patients, monitoring medication usage, evaluation for refills, and occasionally to help triage skin lesions between established skin exam appointments.
Another method is via the use of apps. There are several mobile apps that allow a patient to download the app, pay a fee, guide the patient through the process of taking photos of their skin and providing a history, then waiting for a dermatologist to respond.
The above two methods are direct to patients, however another form of teledermatology consists of primary care doctors or specialists utilizing a platform to directly consult a dermatologist on the care of their established patients.
What are the benefits of offering this kind of service for the patient?
There are a number of benefits to teledermatology.
First and foremost is access to care. The reality is that in most parts of the country, the wait time for a dermatology appointment can be on the order of months.
Second, avoiding lost time from work. Another reality is that once you do take the time to go to a dermatology office, there can often times be a wait in the office to be seen. The volume of patients that dermatologists must see on a daily basis to attempt to keep the wait times for an appointment on the order of months instead of years can often lead to loss of productivity.
Lastly, it is an effective way to triage common disorders with routine or common first line treatments.
What are the benefits of offering this kind of service for the physician?
For me, the benefit is that I can help provide patients with another point to access care directly and decrease wait times. As for offering this service to primary care doctors, the benefit is the ability to help triage various conditions and help guide my colleagues on care prior to being seen in my office.
What are some kinds of skin-related conditions or instances where it would make sense to use this kind of service?
For my practice the most effective use of the teledermatology platform we offer as an extension of our electronic records is for acne. Acne can be managed very effectively through this type of platform especially when an initial point of contact has already been established in office. Monitoring the effectiveness of medications is helpful and more satisfying for patients.
What are some kinds of skin-related conditions or instances where it wouldn't make sense to use this kind of service?
I simply prefer to not evaluate moles or pigmented lesions via the teledermatology platforms. I tend to view these lesions through a dermatoscope and do not find that a photo from a distance will be helpful. There are many times these photos can be misleading.
Skin cancer screenings overall cannot be performed safely in my opinion through these sites. We are limited by the field of view a photo can provide.
There are lots of advantages and disadvantages to the platforms available. The ideal use of an app is for an established patient that has already been evaluated in person and has an established relationship with this dermatologist to utilize the platforms offered as an extension of their care. The use an app for a complicated condition, moles or freckles, disorders that may require a biopsy or further blood work, conditions that require communication with your primary care doctor, wound care management, etc – will be a bit unsatisfying because it would be difficult for a full evaluation and appropriate management to occur via an app.
One of the biggest downsides for these apps is simply that much of what we do is treating or managing patients with biopsies, injections, freezing etc… To use an app for something that may require an intervention will be a bit of a waste of money because there is a good chance you will have to ultimately make an appointment to be seen in person and pay another cost for a copay for this evaluation.