10 Questions You Should Ask When Choosing a Dermatologist

10 Questions You Should Ask When Choosing a Dermatologist

201605-directderm-questions-you-should-ask-dermatologistAt DirectDerm, we believe that the quality of a dermatology service is rooted in the training, experience and skills of the dermatologist – whether in person or in a virtual setting.

Whether considering virtual dermatology care or services in a brick-and-mortar clinic, we encourage patients and providers to investigate their options so they can make an informed decision.

Here are 10 questions we suggest as a starting point.

  1. Will my care be provided by a board-certified dermatologist? Where did your dermatologists receive their training? Are they licensed to practice in my state?
  2. If I give my permission, will the dermatologist work with my primary care physician or other healthcare providers and share my medical information with him or her? Do you comply with HIPAA standards for sharing and confidentiality?
  3. Besides photos of my skin problem, do you also require my medical history and a description of my condition and symptoms?
  4. After the initial assessment, will I have access to the dermatologist so I can ask follow-up questions?
  5. What happens if I have something serious – like skin cancer? Or what if I need surgery or other intensive in-person follow-up? Can you refer me to a qualified expert in my area?
  6. How soon will I receive a diagnosis and treatment plan after I have submitted my information?
  7. Are your services covered by my insurance?
  8. What if my skin problem needs to be evaluated by a subspecialty expert, such as someone who specializes in skin cancer or pediatric skin problems?
  9. What if I need a prescription? How can I be sure it won’t interact with something I’m already taking?
  10. Where can I go to find an independent, objective overview of your physicians? For example, are your doctors profiled on HealthGrades?

At DirectDerm, we believe that the quality of a dermatology service is rooted in the training, experience and skills of the dermatologist – whether in person or in a virtual setting.



Study Says Virtual Dermatology Helps Bridge the Gap to Specialized Skin Care

Study Says Virtual Dermatology Helps Bridge the Gap to Specialized Skin Care

201605-directderm-JAMA-bridge-the-gapThe number of patients who received care from a dermatologist nearly doubled when DirectDerm’s “virtual dermatology” services were offered. And among those newly enrolled in the Health Plan under the Affordable Care Act, 75 percent of those who received dermatology care, received it virtually – through DirectDerm.

A study in a prestigious medical journal, JAMA Dermatology, appears to confirm something we’ve been talking about for a long time: For people who have little or no access to a dermatologist, DirectDerm’s teledermatology service can make specialized skin care more readily available.

We weren’t involved in the study, but DirectDerm was its focus – specifically, our collaboration with Health Plan of San Joaquin, a California managed care plan that wanted to make it easier for patients covered by Medicaid (known as Medi-Cal in California) to obtain dermatologic care.

According to independent researchers at RAND Corporation and Harvard Medical School’s Department of Health, this goal was reached: The number of patients who received care from a dermatologist nearly doubled when DirectDerm’s “virtual dermatology” services were offered. And among those newly enrolled in the Health Plan under the Affordable Care Act, 75 percent of those who received dermatology care, received it virtually – through DirectDerm.

It’s not uncommon for patients covered by Medicaid to have little access to dermatologists, but there are many other factors that can put specialized care out of reach. Because of a national shortage of dermatologists, patients in urban areas may have to wait two months or more to be seen; wait lists in rural regions often start at six months.

Anyone with an itchy rash, painful sore or worrisome spot or mole knows this is far too long to scratch, experiment with lotions and creams, and wonder and worry.

You can access DirectDerm from virtually anywhere at any time. Within 48 hours and often less, you receive a diagnosis and treatment recommendations, which may include over-the-counter medications, prescription drugs or both. And we work with local primary care physicians and dermatologists as part of a full network of care.

We’re always here for your skin health,

David Wong, MD, PhD, CEO


David Wong

CEO and Co-Founder of DirectDerm
Virtual dermatologists

Virtual dermatologists

Canadians have longer waits to see a medical specialist than most other industrialized nations.That’s according to a report by the Canadian Institute for Health. A virtual dermatologist and a smart phone just might be one way to bridge the gap.

Health Plan of San Joaquin is a managed care plan that serves more than 380,000 people living in California’s Central Valley.  In 2012, the plan began offering virtual dermatology referrals through a company called Direct Dermatology.  In the beginning, GPs and internists referred patients to a virtual dermatologist  complete with background information about the patient plus photos of the rash or skin lesion – both uploaded to a secure web site. The virtual dermatologist would give an opinion about the rash to the referring doctor within a few days

More recently, patients have been referred to a bricks and mortar building where they are interviewed and photographed first by a nurse.  If necessary, a skin biopsy can be done there too.

So far, the program has been quite successful.  Researchers from Rand Health  the largest independent health policy research program in the U.S.  crunched the numbers. Of close to 400,000 patients in the plan, 8614 were referred a dermatologist.  Overall, half the patients saw a dermatologist in person, and half had a virtual appointment.  After the U.S. Affordable Care Act came into effect in 2014, more than 108,000 new patients entered the plan.  Of the newbies referred to a dermatologist, one quarter saw one in person and three quarters had a virtual appointment.

That means access to virtual dermatologists enabled the plan to keep with a huge increase in the demand for dermatology referrals. It did so despite the region having far fewer dermatologists than the national average.

Like other specialties in medicine, virtual dermatology has attracted its share of critics.  They maintain that no one – not even a dermatologist who often makes spot diagnoses based on the typical appearance of a skin lesion –  can diagnose a patient without seeing them in person.  Texas and other states in the U.S. have tried to put the breaks on virtual appointments.

I like the way Health Plan of San Joaquin adapted its virtual dermatology program to anticipate that objection. The bricks and mortar clinic I told you about also serves as the place where the virtual dermatologist can refer patients with more complex skin and other conditions for a more complete assessment by a dermatologist in person. The use of the physical clinic is reassuring.  In the study, those who received a virtual appointment only were younger and more likely to have minor skin problems like acne and warts; those seeing a dermatologist in person were older, had more serious skin problems like cancer, and tended to have other serious medical problems.

I imagine that some of these critics would be dermatologists who might feel threatened by this.  I think dermatologists enjoy being in scarce supply in Canada.  They get to schedule delayed appointment – by which time the skin rash has either gone away, or is so easy to diagnose that even a medical student can offer a correct opinion.  If dermatologists lose significant business to virtual colleagues, then more and more of them will go the virtual route themselves.

Smart phones work surprisingly well with virtual appointments.  A 2015 study by researchers at the University of Pennsylvania found that a smart phone app can help doctors prioritise referrals to a virtual dermatologist.  In another recent study, researchers in Sweden and South Africa recruited subjects to rate the quality of photos taken by various smart phones – and compared them to photos taken by a digital camera.  The image quality generated by the smartphones was just as good.  Add-on devices are being developed that can enhance today’s smart phones to the point where they might be able to help detect cancer.

It’s tempting to say that what happens in health care in the U.S. is not applicable to Canada.  In this case, I think that’s incorrect.  Virtual access to a dermatologist under the Health Plan of San Joaquin is not a marketing gimmick to generate income.  The Health Plan of San Joaquin is not for profit.  Like Canada, it provides publicly funded health care – in this case – under contract to California’s Department of Health Care Services.

What is different to me is that the U.S. is more willing to try new ideas.  In Canada, we let fears of breaching patient privacy act as a break on the development of virtual medicine.  That’s changing, but not as fast as I’d like and, as we need to keep up with an ever-increasing demand for services.

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TELEDERMATOLOGY CAN HELP: A RAND/Harvard study shows that skin-doctoring-at-a-distance makes it easier for patients to get specialized care. The researchers studied a collaboration between Palo Alto, Ca.-based Direct Dermatology and Health Plan of San Joaquin, a Medicaid managed care plan with nearly 300,000 enrollees in an area where immigrant farmworkers get their share of skin conditions. “Patients covered by Medicaid have traditionally been one of the groups with limited access to dermatologists, but teledermatology is making it possible for patients to receive the care they need through a network of primary care physicians, teledermatologists and local dermatologists,” said Dr. David Wong, CEO of Direct Dermatology (now DirectDerm).

Sunscreens & Your Skin

Sunscreens & Your Skin

201605-directderm-sunscreens-your-skinSunscreens are a key component to your daily sun protection regimen to decrease your risk of skin cancer and reduce the effects of skin aging.

How to select a sunscreen:

Select a water-resistant, broad-spectrum sunscreen with a SPF of 30 or higher.

SPF stands for Sun Protection Factor. The higher the SPF, the more protection from ultraviolet B (UVB) rays, which prevents sunburn. But SPF does not tell you about the level of ultraviolet A (UVA) protection.

A broad-spectrum sunscreen protects against both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Both UVA and UVB increase your risk of skin cancer and cause skin aging. The best broad-spectrum sunscreens have the following 2 active ingredients: avobenzone and octocrylene (look for them on the list of active ingredients on back of bottle).

How to use a sunscreen:

Generously apply sunscreen to exposed skin EVERY DAY, 30 minutes PRIOR to going outdoors. Re-apply the sunscreen every 2 hours even on cloudy days or after swimming or sweating heavily.

You should be using one ounce, enough to fill a shot glass, each time, in order to cover typical exposed skin, including your face, neck, chest, and arms.