The virtual cosmetic consult

Telemedicine can be a much appreciated service for cosmetic patients and even a practice builder, but physicians must approach with caution, says American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Stephen S. Park, M.D.

Dr. ParkDr. Park, who practices at the University of Virginia in Charlottesville, Va., says doctors can — and do — use telemedicine in various ways. In its simplest forms, virtual patient communication takes place with text messaging or email. Live platforms, including Skype or FaceTime, add a visual component. Academic centers around the U.S. offer specially designed telemedicine rooms equipped with high-definition cameras for live communications between doctors and patients, as well as doctors and colleagues around the world.

Cosmetic surgeons today are more frequently conducting virtual consultations, engaging with potential patients and managing patients postoperatively with telemedicine. Dr. Park uses telemedicine in two ways. One is to engage (or not) with people who reach out to him by email or other digital means.

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“I would say that roughly half of random e-mails for medical advice are deleted without opening, particularly those that are a part of a mass e-mail to a large number of surgeons. When the e-mail begins with 'Dear doctor, can you help me...'  it will likely be deleted quickly," Dr. Park says. “… many attorneys would say, as soon as you reply, you’ve started a relationship.”

But emails and other correspondences from people who might be credibly referred or acquaintances are a different matter, he says.

“I’m completely OK with starting that relationship,” Dr. Park says.

He also uses telemedicine as a service to his existing patients, where for practical purposes, he can conduct such things as wound checks, post-op visits or allay patients’ concerns. For example, a patient might send him a picture of an area of concern. Dr. Park can respond by either putting the patient at ease or requesting that patient come to the office.

In some cases, video is better than still photos. A cosmetic surgeon can’t evaluate the effects of Botox with a still photo, for example.

Virtual communication can also make educational marketing more effective, Dr. Park says. A cosmetic surgeon, for example, might host a symposium on advances for aging faces and invite patients and potential patients to join in an interactive session via teleconferencing. Even in these situations, however, doctors can’t let their guards down and should avoid talking with patients specifically about their cosmetic concerns, according to Dr. Park.

Avoiding Virtual Casualty

Avoiding Virtual Casualty

Telemedicine or any form of electronic communication — even when it doesn’t involve video or cameras or a pre-existing doctor-patient relationship — exposes cosmetic surgeons and other doctors to medical-legal issues.

Uttering even well-meaning advice before you’ve established a patient-doctor relationship in a face-to-face consultation can put doctors’ careers in jeopardy. Dr. Parks advice? Proceed with caution. Even professional-grade video conferencing technologies don’t take the place of a face-to-face consultation, where the cosmetic surgeon can fully assess the patient. That includes palpating areas, when needed, and assessing patient body language that may help reveal things like body dysmorphic disorder (BDD) and other issues that may affect treatment candidacy.

For example, “You should never give definitive medical advice about a rhinoplasty through email. Of course, you need to see [the nose],” Dr. Park says. “Many would argue, you cannot give medical advice just by seeing it, without being able to touch it.”

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There are also nuances with telemedicine that make it more likely for the surgeon to miss something important, according to Dr. Park.

Seeing only a patient’s face on Skype might not reveal the picked scabs on that patient’s arms. Patients that don’t groom themselves (which would be hard to see when a camera focuses on one area) tend to make less cooperative surgical candidates, he says.

“You can miss some subtleties of a normal bedside interaction. Some of those subtleties might be red flags [that tell you] not to operate,” he says.

2 Ways to Protect Yourself

2 Ways to Protect Yourself

What can cosmetic surgeons do to protect themselves? The first thing: full disclosure.

“[That means] telling them, very specifically (and as awkward as it is) that you’re not giving personal medical advice,” Dr. Park says.

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The second thing cosmetic surgeons should do before engaging in telemedicine: obtain consent.

“That’s especially useful when you’re going to utilize [telemedicine] with pre-existing patients, especially for post-op. On occasion when patients come from far away, even overseas, you may plan to communicate through telemedicine post-operatively. That requires very specific consent,” Dr. Park says.

Your First Virtual Consult

Your First Virtual Consult

To get started, a doctor needs a desktop computer, cell phone or tablet with internet. Popular applications, like Skype, can be used for video communications. There are also applications designed specifically for healthcare providers and their patients, such as Practice Unite, which is a platform used for HIPAA-compliant mobile between physician-patient and physician-physician communications, according to a recent AAFPRS press release.

Of course, getting started also means taking the proper precautions to avoid legal and other problems.

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Dr. ManolakakisDr. Manolis Manolakakis, Shrewsbury, NJ, tells Cosmetic Surgery Times that his first virtual consult with Skype was better than expected, noting that "there's a way to do a [Skype] screen share with your consult to go over before and after photos." However, Dr. Manollakakis points out that you "also still need a formal in-person consult to discuss and finalize a treatment plan." His tips for your first virtual consult include ensuring both patient and physician are in a quiet room with good lighting and a good internet connection. 

The Future of Telemedicine

The Future of Telemedicine

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According to Dr. Park, one of the biggest next-horizon advances is going to be robotics surgery.

“The natural extension of telemedicine is robotics, where, in fact, we’re doing not just performing their [patient] consultations from a great distance, but their procedures,” he says.

Dr. Park believes three-dimensional printing will play a role in enhancing patient-doctor communications. Such technology would allow the surgeon to create a 3-D mold of a patient's nose, for example, from a picture. 

Dr. Park's prediction for telemedicine: It's only going to get more advanced.