Telederm: good friend or foe

Pearl Kwong, MD, PhD, a pediatric dermatologist in private practice in Jacksonville, Fla., caught the attention of her audience at this year’s meeting of the Society for Pediatric Dermatology with a hilarious introduction. When discussing how often GPs would call them (constantly!) during the peak of the pandemic, Dr. Kwong: “I finally got her to stop calling me all the time when I would reply, ‘Hello, me.’ I’m in the bathroom: What do you want?'”

This light-hearted beginning gave way to a brief look at the different types of teledermatology available: synchronous (live, real-time video visits); asynchronous (save and forward videos); mixed (store and forward and live); and teledermatology between general practitioners and dermatologists.

“Telemedicine is not a new concept,” Kwong said. “Historically, classic examples of where telemedicine was (and is) ideal are found in the fields of radiology, prisoner health, psychiatry, and home health care.” Before COVID-19, however, there was resistance to telemedicine on all fronts, including a lack of trust in it the diagnosis, lack of resources and platforms, insurance reimbursement was not adequate and over-regulated (depending on which state you practiced in).

Then came COVID-19: usage increased, HIPAA restrictions were lifted, more effective platforms emerged, and both patients and healthcare providers adapted.

For dermatologists looking for tips on how to televise most effectively, Kwong pointed to organizations that offer help, such as: B. Telemedicine pages on the AAD, AAP, and SPD websites.

However, challenges for practitioners remain, such as B. correct payment (coding issues), images patients upload (which may be blurry or otherwise unclear), and accommodating HIPAA violations even as HIPAA relaxes some of its restrictions.

“It can be exhausting talking to a patient who’s walking around her house, showing me her messy rooms, going outside trying to get a good signal, or misaligning her phone or tablet,” Kwong joked. “The person’s ceiling is my most common view on a telemedicine call.” Other strange settings include a patient’s car (“Are you actually driving while you have that TV visit?”), the grocery store, or a vacation to Disney World. “I’m just waiting: every day someone will arrange to watch TV while screaming and holding their arms up at Magic Mountain.”

Additionally, the lack of human interaction and rapport adds to the challenges of telemedicine, says Kwong, not to mention the eye strain from sitting at a screen that much. Nonetheless, according to Kwong, Telederm also means less time away from school for a patient, being able to make a last-minute appointment, less downtime for parents, and “no need to wear masks at both ends: you can see the whole face.” Your patient!” During waves of viruses like COVID-19, there is also a reduced risk of infection for patients and doctors.

Bottom line, Kwong summarized: Teledermatology has come to stay with its benefits and challenges. Future research is still needed to optimize the technology, policies and regulations need to be reviewed and established, and more education is needed to educate all practitioners on the rules and regulations of teledermatology.


Kwong P. Teledermatology: friend or foe. SPD 2022 47th annual conference. July 8, 2022. Indianapolis, Indiana.

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