PracticalDermatology

My grandparents were born before cars roamed city streets, and yet they lived to see computers and cell phones become commonplace, which I always thought was uniquely dramatic. Clearly, the fact that I was born before man walked on the moon and will likely see artificial intelligence (AI) outperform the wildest dreams of ‘2001 A Space Odyssey’ is another remarkable contrast. Reflecting on the notion of ‘all things are local,’ how has technology affected our specialty, and what can we expect for our future and the future of those starting out in dermatology now?

When I first started my practice in 1992, the worst technology issues we encountered were when the paper charts fell behind the file cabinet and were lost forever. While we never ‘lose’ a chart physically anymore, there are more ways to lose control of a chart than steps in a preauthorization for Dupixent. There is a tension between the inexorable pace and call to modernize, despite the inherent and inevitable loss of control and potential for disasters that could affect reputations and/or lead to exorbitant fines or costs. There clearly are some thrilling benefits of technology, ranging from access to our medical records from halfway across the world to the ability to obtain a picture of a patient from the comfort of our home via text. This has allowed many dermatologists to avoid a lonely trip to the office at 11PM to see patients to make sure they don’t have Stevens-Johnson syndrome or a hematoma of their flap. Score one for technology.

Additionally, the ability to see clinical progress or lack thereof in my patients by comparing pictures has honed my practice style significantly, allowing me to take pleasure in the improvements I see daily. It also allows my patients to understand the value I offer as their dermatologist and the fact that I care enough to track their progress and hold myself to a standard in their care. It has absolutely changed my practice in many ways. 

The advent of telemedicine is one other major success in technology. Without this, I would have been lost during the pandemic. Our EMR system, NexTech, was able to implement telemedicine within 4 days of the pandemic’s lockdown, which was an astonishing feat. This allowed us to retain our entire staff throughout the pandemic and led to healthier patients with better outcomes during and after the pandemic. We continue to utilize telemedicine in many forms and will always be grateful for its impact on our practice. 

The adoption of e-learning has been a huge success, with options for taking board-exams in your city (does anyone remember lugging their microscope and copies of Rook and/or Fitzpatrick texts to the Rosemont Marriott for boards?), fulfilling ongoing CME requirements or simply looking up a long-forgotten condition on eMedicine. 

The ten-ton gorilla in the room, however, is AI. Will we be swallowed up by it or will it possibly enhance our abilities, carefully editing our electronic notes and suggesting diagnoses from the constellation of symptoms and pictures that our nurses document, even before we reach the room (much like the EKGs already suggest that someone has a left bundle branch block)? I do look forward to hearing the view from the bleachers on every patient (“Joel, did you consider that this patient may have dermatitis herpetiformis?”), but also may feel the desire to shout at my iPad as I sometimes feel the need with Siri. Only time will tell…

Rather than pigmented lesion detectors (which probably won’t be adopted by dermatologists if the overall effect is to encourage fewer biopsies and procedures and shoulder more risk if they turn out to be a melanoma), I would appreciate AI for administrative assistance. Though nothing will ever replace the ability for me to discuss a difficult coding question with one of my staff, AI seems ripe to supplement billers, coders, appointment bookers and other support staff. I don’t really see that my nurses will ever be replaced.

We must prepare for technology to integrate with our lives even more over time, and ignoring it comes with perils, too. Just as we see those who still refuse to learn how to email or shop online as hopelessly out of touch, without proper education about new technologies, we too could be the equivalent of dermatologists who still won’t adapt to the current practice of medicine. The question is which technology is going to be prevalent and which is worth purchasing when the eye-popping prices to convert to the latest, greatest system is posed to us. My hope is that someone smarter (and likely younger) than me will be able to make that decision!