Teledermatology Mentoring Moment

Brea Prindaville
Robert Sidbury
Hanspaul Makkar

Brea Prindaville, MD, Brown University, Providence, RI
Robert Sidbury, MD, MPH, Seattle Children’s Hospital, Seattle, WA
Hanspaul Makkar, MD, University of Connecticut, Farmington, CT

Interviewers: Andrew Blundell, MS4 & Elena Hawryluk MD, PhD

1. During this time when our clinical practices have been drastically impacted, are there any new digital or teledermatology endeavors that you have been surprised by, or enjoyed?

BP: While this time has reinforced that I prefer in-person visits for the interaction and ease of diagnosis, I have found teledermatology visits to be heartwarming. There is something even more personal about being welcomed into a family’s home and spending a few minutes experiencing this strange time in our lives together. Parents really appreciate that we can help them while keeping them safe. A lot of the children are excited to see “a doctor in the computer!” and can’t stop waving or sharing their toys.

RS: The biggest surprise has been how challenging I have found practicing exclusively digitally can be. At the end of the day, I am exhausted regardless of how many patients I have “seen.” I did not expect this. Live teledermatology has been a part of my practice for many years; the University of Washington has a very broad catchment area, including multiple states (WAMI region--Washington, Alaska, Montana, Idaho), so we have always needed to extend our reach. Twice a month, I have had a clinic where I see patients at distant sites through high-resolution equipment on both ends. I have always very much enjoyed these clinics and never felt tired at their conclusion.

What’s the difference? I am not certain but presume it is due to several factors: 1) simply the lack of diversity. Now, this is all I am doing as opposed to just a couple of times a month. 2) There are inevitable technical hiccups that can be cumulatively draining. 3) It is isolating. We interact with the family, but we don’t interact with our MAs, our nurses, our colleagues. 4) The fact that digital interactions, even when live and interactive, are not the same as in-person interactions. All of these things contribute, but the last two, I think, are the most critical. Practicing medicine is, at its core, human interaction, and in the current context, there is less of it, and what there is seems “filtered” somehow through technology.

HM: Before the pandemic, I was resistant to incorporating telederm into my practice because of the challenge of rendering diagnoses based on poor quality photos or videos. I have been surprised by the quality and ease of use of many telehealth platforms, and I have found that by asking parents to send digital photos ahead of their visit, rendering diagnoses is less problematic. Children are much more comfortable at home and, with video technology, are more at ease interacting with me from their couch alongside their parents than on an exam table in my office. With this ‘fear’ factor reduced and the inherent comfort of being in a familiar environment, the patient-physician encounter is much more relaxed, allowing the visit to be more focused on diagnosis and counseling rather than the anxiety of 'seeing the doctor.' As one toddler astutely pointed out to me: “You can’t give me a shot!