How I Practice Now: Overcoming the Challenges of Teledermatology

In this video, Consultant360 Board of Consultants member Barbara Wilson, MD, discusses the challenges of shifting a dermatology practice from in-person appointments to teledermatology, including learning new systems for video calling and the advantages of photos over video for analysis of lesions, as well as the opportunity for this shift to allow dermatology to embrace telemedicine in the future for the benefit of patients who need it.


Barbara Wilson: My name is Barbara Wilson and I'm an associate professor of dermatology at the University of Virginia.

I've been asked to talk today a little bit about how the COVID-19 virus has affected our practice in dermatology. We have a busy dermatology clinic at the University of Virginia, and when this happened, we essentially, and quite early, canceled clinics probably earlier than I really had expected. And that's involved a lot of phone calls to patients who already have waited a long time for an appointment and having to change their appointments for three months, six months down the line. And we've been very busy doing that. Just a lot of phone calls and rescheduling.

We decided to still man the clinics, but instead of having all of the faculty and residents present, we have one attending and one resident covering that day, and we of course still see patients who are urgent, especially patients we'd like to keep out of the emergency room right now as busy as they are. So, if there's something that a patient has that might take them to the emergency room, we of course will have them come to dermatology clinic—painful skin cancer or a inflamed cyst or a rash. So, we certainly will continue to see urgent patients and sometimes it's just an anxious patient who doesn't think that they can wait. But the number of patients has been greatly decreased from maybe 150-180 patients a day down to 10 or 20.

The main thing that's changed for us is teledermatology, and I, as somebody over 60, spent an awful lot of time trying to figure out the technology which comes so easily to the young folks. We've been trying to offer teledermatology for a long time, and we have offered it to some very rural areas and prisons where insurance has agreed to reimburse that activity, but we haven't been able to get teledermatology off the ground, really because insurance hasn't wanted to pay for it. But now we are doing that, and there have been a lot of changes and a lot of exceptions. The university's very involved with helping us get set up to do teledermatology and a lot of the come to fruition, but we are at least told that it's a covered service.

And so now, this is slowly getting up and running and some people are doing more than others. As someone has been around doing dermatology for so long, most of my patients are just skin checks, where I need to very closely examine their skin. And that's not very amenable to teledermatology—a little tiny two-millimeter basal cell in the alar crease isn't going to show up on a video call, but a number of things can be managed—acne, some rashes. Some lesions, if very good photographs can be taken, then sometimes we can accomplish a visit. It might be just a refill of a medication, depending on how a bad their eczema is doing.

So, this is going to be a good outcome, I think, of this pandemic for our practice. I think that teledermatology is going to be a much bigger part of many practices. And I think that's especially important for a place like the University of Virginia where we have people that might drive 3, 4, or 8 hours to see us. And we can save some patients a visit by being able to do that over Zoom or, (these are some of the things that we've been trying where we can actually interact with a patient), either with live video or in some cases having them send photographs. And I will say, especially as someone who mainly looks for skin cancers in my patients, a still photograph, well taken with good lighting, can often tell me a lot more than a video which may be have a lot of movement in it and be very blurry. But this will be a good thing that I think we're all going to be more able to know how to do and get the insurance companies on board and realizing this is a good thing for patients.

Barbara Wilson, MD, is an associate professor of dermatology and the University of Virginia.

For more on COVID-19, visit the COVID-19 Care360.