Here’s What You Need To Know About Virtual Consultations

Setting up a consultation or appointment with a medical professional used to involve a phone call and a calendar check. Conducting the consultation or appointment, meanwhile, required an in-person trip to the provider’s office. But, with the advent of modern technology, the scheduling of and participation in consultations and check ups now have a virtual twist. Doctors and patients are increasingly conversing from the comfort of their own homes when time is of the essence or circumstances prevent them from meeting face to face. The concept of telemedicine is nothing new, but, in the wake of the COVID-19 pandemic, it's more important and useful than ever.

With elective surgeries cancelled in many states and private practices closed due to coronavirus, video chats have become an integral part of healthcare and aesthetic medicine. For cosmetic dentists, dermatologists, and plastic surgeons, telemedicine is a way to connect with patients from the very first consultation to ongoing post-op care.

If you’re interested in setting up a virtual appointment with a provider but don’t know where to start, we’re here to help. To break down the logistics of what telemedicine can and cannot address, how patients need to prep for appointments, and what happens after the call, The AEDITION spoke to board certified dermatologists, plastic surgeons, and dentists to understand the ins and outs of virtual consultations.

Virtual Consultations in Aesthetic Medicine

In aesthetic medicine, virtual consultations have long been a way for providers to connect with and assess out-of-town patients. “The purpose of a virtual consultation is to identify the patient's chief complaint and determine what additional information is needed to address the problem,” says Alina Lane, DDS, a cosmetic dentist and director of All Smiles Dentistry in New York City.

While there are certainly some screen-induced limitations, virtual consultations generally offer both patients and providers an opportunity to get to know one another and discuss areas of concern, aesthetic goals, and possible solutions. Many doctors find that they’re able to treat their patients with the same care despite the lack of proximity.

Generally speaking, here’s how telemedicine works for aesthetic specialities:

Virtual Consultations With a Dermatologist

Whether you’re worried about a rash or need a refill on your Retin-A prescription, dermatologists can address both medical and cosmetic concerns during a telemedicine appointment. Technology doesn’t yet allow for virtual injections (sorry, Botox® fans!), but a dermatologist can assess your skin and prescribe a treatment plan to address unexpected flare-ups (think: acne, eczema, psoriasis), soften fine lines and wrinkles, or maintain a youthful glow between in-office appointments.

For those worried about a troubled mole or a sudden rash, virtual consultations still serve a purpose — though they may just be a first line of defense. “Yes, we can make a diagnosis and evaluate basic skin conditions,” says Morgan Rabach, MD, a board certified dermatologist and co-founder of LM Medical in New York City. “[But for] something like a melanoma, which is life-threatening has to be treated immediately, the patient would be seen in person because it is medically essential.”

Virtual Consultations With a Dentist

“By its nature, dentistry is a very interactive medicine,” says Dr. Lane, who offers virtual consults. “Many dental diseases require in-office procedures to treat.” While regular dental check ups are needed at least once a year, unexpected issues can arise that require immediate attention. “Dental pain, facial swelling, abscesses, and broken teeth are all major indicators that an in-office appointment is needed,” she notes. “However, during this time of shelter-in-place, the urgency of these matters can be evaluated first by a virtual consultation.”

Those dealing with dental emergencies will first be evaluated virtually to confirm if immediate care is needed. “If there is a dental emergency, we will determine whether we can manage it remotely or if an in-office visit is required,” she explains. “During a time when hospitals are being strained due to the COVID-19 outbreak, our goal as dentists is to minimize all emergency room visits due to dental problems, which will help to reduce strain on the medical system and minimize patient exposure to infected persons.” As such, many dental offices have remained open to treat emergencies.

Virtual Consultations With a Plastic Surgeon

While a telemedicine appointment might not allow quite the same level of interactivity as an in-person consultation, they still provide a meaningful way for providers and potential patients to get to know one another. “Virtual consults are a good first step for someone to see if they are interested and also get a chance to know me and what we can offer,” says Jaime Schwartz, MD, a Beverly Hills-based board certified plastic and reconstructive surgeon who also has a practice in Dubai.

During this time of social distancing, the virtual meeting is also a good chance for providers to interact with the caregiver who will be tending to the patient once he or she heads home to recover post-op. “It can help to have a family member or spouse available for the consultation as well, so that they can be informed on what to expect after the procedure if the consultation is for a surgery,” says Craig Baldenhofer, MD, a New York City-based board certified plastic and reconstructive surgeon.

Setting Up a Virtual Consultation

Ready to book? Here are six things to keep in mind ahead of your appointment:

1. Prepare For Paperwork & Pictures

“Prior to the consult, patients fill out the standard office intake forms; are emailed copies of the procedure consents, pre-operative and post-operative instructions to review; and are given instructions on how to provide photographs for me to review prior to the telemedicine visit,” Dr. Baldenhofer explains. The dermatologists we spoke to follow a similar protocol, so be ready to take lots of pictures. “We have a photo guide that explains how to take pictures of the face and body that is sent to our concierge team who evaluate the images,” says Jason Emer, MD, a board certified cosmetic dermatologist in West Hollywood, who frequently travels to New York to treat his East Coast patients. “If they’re not good quality, they’re sent back. There’s different positioning and different lighting that’s needed.”

Precisely shot photographs will likely be necessary for any and all consultations, but they are especially vital when patients are looking to consult about concerns below the neck. For breast and body procuedres and surgeries, providers can review photos submitted ahead of time, rather than examining the area during the video chat.

2. Consider Your Safety First

When it comes to virtual consultations, patient privacy and safety are the top priority. “We have always had the capability and use Skype or FaceTime for consults for out-of-town patients,” says Lesley Rabach, MD, a double board certified facial plastic and reconstructive surgeon and co-founder of LM Medical. “However, now we are using Doxy.me, which is a better-secured platform for physicians to do our telemedicine consults.”

In fact, the Health Insurance Portability and Accountability Act (HIPAA)-compliant platform is quite popular due to its security and convenience. “It can be used with any computer or smartphone with a camera,” Dr. Baldenhofer says. “Patients are emailed or texted a link to a virtual waiting room and told to be available at the prearranged time. Once they are in the waiting room, I am alerted and can start the consult.” If you have any questions or concerns about the security of your virtual consultation, ask your provider what platform they use and the protocols they have in place to protect your privacy.

3. Be Mindful Of Your Set Up

Treat the call as if you were going into the provider’s office. You’d want the environment to be quiet and serene — without interruption — so try to do the same with your home surroundings. “I have had patients try to have a virtual consult while driving their car and that was not ideal,” Dr. Baldenhofer shares. While the photos provided ahead of time will play the biggest role in your consultation, there are some things you want to keep in mind when considering where you are going to sit for your appointment. In addition to being in a well-lit location, place the screen at a comfortable height and distance to avoid the so-called ‘selfie’ effect that can distort the appearance of certain facial features.

4. Know Who You’re Speaking To

Though a patient might set up their video consultation through a web portal or by calling the doctor's office, the consultation will likely be with the doctor. “I perform all of my consultations — virtual and in real life,” explains New York City-based board certified plastic and reconstructive surgeon Melissa Doft, MD. “I enjoy meeting with patients beforehand to understand their aesthetic goals.” With that said, some practices may have a nurse or patient coordinator kick off or join the call, so feel free to ask about who you will be meeting with when you schedule the appointment.

5. Come Prepared

As with any consultation, be prepared with questions, a clear vision, and an open mind. “By the time the telemedicine visit starts, I have already had the opportunity to review the patient’s medical history and photographs,” Dr. Baldenhofer says of his pre-consultation protocol. “Therefore, It’s more of a conversation to go over any questions and discuss the risks and benefits of the procedure.”

Similar to a regular visit, any concern can be discussed during a telemedicine visit, but assessing can be tricky. “Any aging face consults are very easy to do during a virtual call – especially if the patient can send in photos of themselves in certain positions prior,” Dr. Lesley says. “For rhinoplasty cases, I cannot examine the inside of the nose, however, I can still see the external nose and make assessments.” In the case of medical dermatology inquiries (think: a concerning mole), the provider can discuss the area of the concern, but will not be able to diagnose without a biopsy. “[Melanoma] are impossible [to diagnose] by visual sight,” Dr. Emer says. “If you have a problem spot, I will recommend you to a Mohs surgeon.”

6. Ask About Consultation Fees

The cost of a consultation — virtual or otherwise — depends on the doctor. Some do not charge for the initial meeting, while others do. In the latter case, the fee usually goes a long way. “We charge the same cost for a virtual consultation as an in-office consultation,” Dr. Doft shares, adding that the fee ($350 in her case) is applied to the cost of the procedure. The consultation fee usually helps to confirm a patient’s seriousness and likeness to to follow through with the procedure. At Dr. Emer’s practice, a virtual consultation with one of his aestheticians, skincare specialists, or physician assistants results in a personalized product regimen and credit to shop. “They pay $150 per consultation, but that goes towards the credit of the product,” he says. “They’re getting recommendations for products that will treat almost any concern and help them treat it from home.”

What Happens After a Virtual Consultation

After a virtual consultation, the best thing to do is to follow doctors orders. For those whose concerns are skin-related, dermatologists will outline the necessary steps that can be undertaken and products that can be used at home before they can come in for an in-office treatment. “We offer skincare solutions, such as peels, that can be applied during a virtual consultation with an esthetician,” Dr. Emer says. “At-home peels prime and prepare patients for laser treatments and it will significantly improve their skin in one treatment.”

Patients looking to go under the knife, meanwhile, should note that further consultations will be needed. “I will never operate on anyone until I see them in person and we review our plans and make sure we are both 100 percent on the same page,” Dr. Schwartz says. The follow-up appointments will also allow surgeons to assess if any pre-op testing is needed. “Sometimes, depending on the age, medical history, and other factors, the patient will need pre-operative testing prior to the surgery,” Dr. Lesley explains, adding that, in some cases, patients will ask for additional face-to-face meetings prior to scheduling a surgery.

As in-person consultations and surgeries are off the table at the moment, surgeons are cognizant of their patients’ desires, budgets, and safety. “We plan to have follow-up in-person consultations once the crisis is over, but the virtual consultation allows us to start communicating with patients, sending in packages to insurance companies for approval, and making the fall schedule,” Dr. Doft says. “Once elective surgeries can occur again, there will be a major rush for operating room space, and we want to make sure our patients do not have to endure long wait times.”

The Takeaway

Whether you’re near or far, a virtual consultation is a viable option for anyone looking to explore their options or get to know a provider. While not every procedure or concern can be addressed virtually, telemedicine allows patients and doctors to communicate their goals, desires, and potential treatment plans. At the end of the day, a video call cannot fully replace an in-person appointment, but Dr. Lesley and Dr. Morgan maintain that there is no reason to not try it. “They are easy and fun,” they say. “It is an amazing way to be productive during this time when we all have to physically be home.”