Whether you’re a seasoned dermatologist or just starting your practice, 2020 has introduced new challenges for us all. We have all had to adapt how we perform in-person consultations and many of us have added virtual appointments as an alternative. Regardless of what type of consultations you are offering, patient care in 2020 looks different in many ways than it once did.
At CSF (Cosmetic Surgery Forum) 2019, board-certified dermatologists Amy Lewis of New York, New York and Mark G. Rubin of Beverly Hills, California each delivered presentations on their best tips for a highly successful consultation. Given that circumstances have changed, we called upon them again to discuss solutions to some of the changes and new challenges dermatologists are facing in the COVID era. We also spoke with CSF founder and board-certified dermatologist Dr. Joel Schlessinger of Omaha, Nebraska to get his thoughts on how things have changed.
Virtual Patient Consultations in 2020
Successful appointments and consultations have always been the pillar of a successful practice, but the way we perform them is changing and, in some ways, more challenging. Mark G. Rubin and Amy Lewis specifically point to the changes patients are noticing in their faces after spending their days working on video calls, what Dr. Lewis calls the “Zoom Doom and Gloom.”
Dr. Rubin says, “Patients have more downtime to examine their faces, and that combined with FaceTime, Zoom and other video platforms which are known for creating the least-flattering video images, peoples’ perspectives of their faces [are changing].”
While this might mean a change in popular procedures, the core of the consultation is the same: What does the patient want, and how can we safely (and most responsibly) assist them?
Dr. Amy Lewis, who is currently offering both in-person and virtual patient appointments in her practice, believes that in most cases, the patient and physician will find an in-person visit more fulfilling. She says,
“A cosmetic consultation involves not only trying to understand the difference between what the patient thinks they want in order to improve their appearance, [but] what the patient really needs in order to achieve that goal. I watch how the patient talks, their expressions and how their dynamic movements change their appearance. This impacts how I would assess what should be done and in what order.”
Knowing how important these elements are to an in-person consultation makes visiting with your patients electronically slightly more challenging. Dr. Lewis points to visual cues patients make in the treatment room that may not be able to be observed when visiting virtually. She also points to several steps in an in-person consultation that are difficult or impossible to achieve online, such as allowing a patient to touch and feel a particular skin care product or showing them an approximate result by moving their skin. There are also upsides, however:
“The advantages to a virtual consultation are more about ease. The patient doesn’t have to travel, expose themselves to a possible contamination via subway, Uber or person to person contact. It allows us to connect or reconnect with cosmetic patient[s] who would otherwise not be able to have a consult at all. You need less staff, less office space and have more flexibility when running behind if you’re relying on a phone [or] video call,” Dr. Lewis says.
Dr. Joel Schlessinger, who has been offering virtual patient consultations since the start of the COVID-19 pandemic, believes that virtual visits might still be on the table in the long run. “It may change as the rules change,” he says. “However, it may even be necessary to go back to fully virtual visits in the future if the pandemic worsens, so it’s best to stay fluid!”
Dr. Schlessinger also explains that if you intend to incorporate virtual visits, his main takeaway has been properly explaining how a patients should plan to “attend” a virtual visit. “Be clear about how to set up the patient’s appointment electronically and have easy and clear directions for the user. We always ask for real photos (iPhone or otherwise) prior to the visit, which helps us to know if they’re serious about showing up for their visit.” Additionally, one of his nurses will call patients the day before their appointment and offer to answer any questions they might have about the process.
Dr. Lewis has chosen to limit cosmetic consults to patients she has already met and has an established rapport with. She says,
“It’s important not to rush through the consult and take time to really listen to what the patient has to say. You may not have the patience to indulge the repetitive questions or banter the patient is seeking… In those cases, have a staff member join in who can seamlessly take over to explain more about what you’ve discussed, and talk about how the patient is coping at home etc.”
Dr. Lewis also goes on to say that virtual consults may also be used as a pre-visit orientation to discuss various procedures that are available to the patient. This would allow you to answer their questions and map out a long-term plan.
In-Person Consultations in 2020
While many physicians have been meeting with patients electronically, Dr. Mark G. Rubin has stood by in-person visits (with some adjustments) as he feels they best suit his patients. In addition to wearing N95 masks and face shields, Dr. Rubin also requires patients to wear masks during their initial consultation. When the discussion is complete, Dr. Rubin asks the patient to remove their mask and instructs them not to speak. “After assessing their face with them looking in the mirror, I then have them put their mask back on and we can discuss the areas I have pointed out to them,” he says.
“On a personal note,” Rubin says, “I find it interesting that when I see a new consultation and spend time talking with them while they are masked I form an image of their appearance in my mind. I am often amazed by how different they look when they remove their mask. What this shows me is that the lower third of the face has a far more profound impact on the patients overall appearance then I previously realized.”
Both Dr. Schlessinger and Dr. Rubin explain face shields, coverings and masks have not changed much about treatment protocols in-office. “If we are only treating the upper face, we keep the patient masked during the entire visit. If we treat the lower face, we have them remove their mask, but only after reminding them not to talk,” Dr. Rubin says.
While Dr. Lewis has adapted to changes like these in her practice, she also has additional tips for in-person consults: “I often step far away from the patient and remove my mask for a few seconds (while theirs is on) to demonstrate what facial expression I would like them to make.” She has also limited the amount of people allowed in the exam room and provides goggles and face shields for all staff.
Drs. Lewis, Rubin and Schlessinger all continue to offer standard treatments with social distancing and face coverings in place while continuing to remain protective of the safety of their staff and patients. The “newness” both Dr. Schlessinger and Dr. Rubin expect to see in the coming months is a demand for rejuvenation on the upper half of the face.
“With the need for constant mask wearing, it seems that the mask and the hairline form a frame that highlights the upper third of the face. This area has become the focal point for many people, so demand for treatments in that area has increased, while perioral treatments are slightly less popular,” Dr. Rubin says.
Has COVID-19 impacted how you perform consultations in your practice? Let us know in the comments below!