Telehealth Best Practices: Dr. Dina Strachan of Aglow Dermatology On How To Best Care For Your Patients When They Are Not Physically In Front Of You

What the technology can and can’t do. Most of the telehealth technology we are using facilitates video conferencing. This may work if the patient encounter is mostly a conversation. It may not work for certain types of exams. I had a patient insist on doing a skin check on video conference. He was concerned about coming in due to the pandemic. The images, however, were simply not clear enough for me to reassure him that his moles were benign. I needed to see them in person.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Dina Strachan.

Dr. Dina Strachan is an internationally-recognized, Harvard and Yale educated, board-certified dermatologist, entrepreneur, consultant, author and speaker based in New York City. Her media citations include The New York Times, The Washington Post, Crain’s New York Business, The Dr. Oz Show, Good Morning America and more. Dr. Strachan has formal training in biomedical informatics from the National Library of Medicine and Columbia University College of Physicians and Surgeons. She has been a consultant to a variety of health and beauty brands. Dr. Strachan is the founder and director of Aglow Dermatology an independent practice located in Manhattan. She holds a faculty appointment at NYU.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

My interest in both dermatology and technology came about for unusual reasons. It wasn’t my personal battle with teen acne, or an interest in cosmetics, that brought me to the field of dermatology. My journey was less glamourous. It was my interested in addressing the AIDS epidemic that led me in this direction. I had a strong interest in infectious disease when I was in medical school which was during the peak of the war on AIDS. Many of the patients on the AIDS service had skin problems that required the assistance of the dermatology team. The skin is, after all, an immune organ. Most of our patients had skin problems. Before then I was under the impression that dermatologists didn’t deal with serious problems other than skin cancer. I was so impressed at how the dermatologists would float into the ward, ask a few questions and quickly solve problems that we had struggled with for days. They had specialized knowledge. They offered a lot of value. I wanted to be able to do that what I saw them do.

As for my interest in technology, I would describe myself as almost a reformed luddite. I trained in San Francisco as the tech boom was ramping up. I wasn’t particularly enamored of exploring tech solutions just for the sake of using technology. It was later, when I was working in an underserved area on South Central Los Angeles that I started to appreciate the potential of some of the information technology innovations. I was one of two board-certified dermatologists in a catchment area serving over 1 million people. The ability to scale and transcend location with technology started to sound appealing when working in those types of conditions. When the pandemic of 2020 happened, I had already been doing telemedicine and quickly pivoted to scale that part of my practice. Still, my relationship to technology is that it should be my tool — not my master. Technology doesn’t always make things better or easier. It changes how we work. I think it’s important that people recognize that. Make sure that tech works for you. Technology should serve people — not the other way.

Can you share the most interesting story that happened to you since you began your career?

I don’t know if other people would find this interesting, but I am surprised that I ended up an entrepreneur with a private practice. It’s even more of a surprise that I am good at it and that I love it. It was never my dream. I had always imagined myself as more of an “artist” supported by an institution that took care of all the business issues that I thought weren’t interesting. When I went into academics and found it to be increasingly corporate, I decided that if I were to have to deal with the impact of this new world of medicine, that I might be happier if I had more control. New York City is so competitive, it’s hard to feel successful here. I had no idea that I had been doing a good job as an entrepreneur until a business coach in a different field of medicine, and from a different region, had brought to my attention that people around the country were actually watching how I was building an independent practice out of nothing in New York. I ended up on the cover of an industry magazine specifically for doing that — building a practice in New York City. It sounded so basic to me. I guess it’s a good thing I didn’t realize it would be hard. If I had, I might not have tried to do it.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life.

One of my favorite quotes is “Give me six hours to chop down a tree and I will spend the first four sharpening the axe” which is attributed to Abraham Lincoln. It reminds me of the importance, and benefit, of preparation before one takes action.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

My first business coach, Phil Laut, was instrumental in my success as a business owner. Years ago, when I was still an employee, someone had recommended a book to me called Money is My Friend. The book was a challenge to find. I had to go to several bookstores. It was before it was routine to just order online. The author was someone I had never heard of. It was an old book, and because I struggled to get a copy, for some reason I figured that the author must be dead. Anyway, I read the book. It introduced me to the idea of mindset and mental programming with respect to business and money. This was a big shift as I had always thought of this topic as being just about numbers. A few years later, shortly after I had started a business and had a baby, I opened an e-mail about an event at which the author, Phil Laut, would be speaking. It sort of spooked me. As I had mentioned, I had decided that the author of this old and obscure book was…on the otherside. I was excited to have the unexpected opportunity to meet him and learn more now that the concepts were relevant to me as I now had a business. I attended the event where I learned about the idea of business coaching. Again, this practice was new to me outside of sports. Phil, however, had been coaching people like me, people who had shifted from being employees to a business owners, for decades. Before then I thought business owners needed only bookkeeping and accounting classes. Business mindset coaching, however, seemed more like therapy — but for business. Intrigued, I decided to become a coaching client of Phil’s. I’m so glad that I did this as it changed my life. He helped me to recognize and navigate many beliefs I had that were obstacles to my success. I doubled my business after three months. I was much happier as a business owner. He opened me up to not only receiving success, but to receiving support. I am eternally grateful to Phil for the gift of these insights. Since then I have worked with many other business coaches. I’m not sure I would have been open to doing this had I not had such a great experience with my first.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

One of the first things that come to mind when I think of the benefit of having a patient in front of me, in my office, versus seeing them remotely is that the office is specifically set up to focus on patient care. I am more likely to have everything I need to take care of them. We can also do procedures if this is necessary.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Sometimes with telemedicine the patients are not in an ideal environment to participate in the encounter. They may not have privacy. The lighting or technology they are using may not be ideal. Even when those things are not an issue, the technology used for telemedicine is really conferencing technology. It wasn’t developed for examination and diagnosis. One might think that all a dermatologist needs is an image but we also touch things and look at them from different perspectives in order to arrive at a diagnosis. This is easier when someone is in front of you.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

1. What the technology can and can’t do. Most of the telehealth technology we are using facilitates video conferencing. This may work if the patient encounter is mostly a conversation. It may not work for certain types of exams. I had a patient insist on doing a skin check on video conference. He was concerned about coming in due to the pandemic. The images, however, were simply not clear enough for me to reassure him that his moles were benign. I needed to see them in person.
2. Privacy still matters. Make sure that your patient know that they need to be somewhere private when they are not in the office where they feel comfortable addressing their medical problem. I’ve had patients be in their cars during their visits, which may seem private, until they may want to show a body part.
3. It’s not okay to multitask during a telemedicine visit. I’ve been in the middle of a telemedicine visit for a baby during which I noticed my patient’s mother seemed to have forgotten that I was there. She had started to respond to a work e-mail as I was explaining how to use the medication I was prescribing to her child. This could have create a safety issue. Patients are saving time not having to travel to the office. Make sure they focus during the visit.
4. Patients also have to have the right technology. During the pandemic, I had a situation in which the adult children of an elderly man kept contacting me to look at a rash. We had to try multiple platforms because the father’s technology was old and didn’t support any of the platforms I used. This took over an hour. The one platform that allowed us to establish a connection provide poor visualization. I couldn’t see what was going on. I had to keep explaining to the children that as much as I wanted to help, I was limited by the fact that I couldn’t see him. Patients can’t get a telemedicine visit if they don’t have the right technology or an adequate internet connection.
5. We should still protect standards and boundaries. We have the capacity to do telemedicine visits with anyone on earth, at any time, so long as we both have access to adequate technology. In some respects we’ve really always had this option since we’ve had the telephone. We shouldn’t forget, however, that this is still a medical encounter governed by rules of professionalism and laws. Sometimes rules can be inconvenient but they protect you. Just because we might be able to reach our doctor when she is out hiking does not mean that that is the ideal time to get her attention. Sometimes it’s best to get care in person where you are, to leave a message at the office, or to wait until you can come in in person. I’ve consulted on legal matters in which both the patient and the doctor wishes that things had not been handled, with the help of technology, from the perspective of convenience.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

I’d say the main advantage of telehealth is convenience. Sometimes a medical encounter is just a conversation. Much of the technology we use was designed for video conferencing so it gets the job done. It’s great that we can now accomplish this part of patient care without either party having to travel. This can save time and money.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

As a dermatologist it’s the basic quality of the camera and the lighting that matter.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

As a dermatologist I’d want software that would provide the perfect lighting, internet connection and resolution for a skin exam regardless of what type of technology the patient had.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

It would be great if patients understood that they still stay present during a telemedicine visit and that they have to have technology up to the task of telemedicine. Not all cameras produce an adequate image. Lighting also matters. They system doesn’t work if there isn’t a strong internet connect.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

I am excited about the diagnostic technology that can be used remotely. Right now the technology is limited with respect to diagnosis.

Is there a part of this future vision that concerns you? Can you explain?

I am greatly concerned at how we sometimes accept a technology solution without evaluating its efficacy and impact. We just look at the stated benefits and accept that that is what actually happen. We’d never do that with a drug. When we consider approving a medication for use we want the data. Consider that long awaited vaccine for Covid-19. Despite the death toll from the illness, many people are concerned about the potential side effects of the vaccine. But we are not, however, also careful with our incorporation of technology into healthcare. We ignore evidence that says it doesn’t have the effects we want. We don’t consider patients outcomes, actual costs, efficiency, burnout and the doctor-patient relationship. We assume a tech innovation is an improvement without the verification. We need to be mindful of this.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Work has become so compartmentalized and individualized that we are losing sight of the fact that we work with other people who may be on a different schedule and who may have different responsibilities. Remote work is different for parents of young children than it is for people who live alone. The rhythm of the shared workday meant that we had a better understanding of what other people might be doing and would naturally consider this when we needed something from them. Now that we work at different locations and at different times we might find ourselves frustrated that when we need something from someone on Sunday afternoon, when we may working, that there may be a delayed response because the other party is also on their own schedule and in a different environment. We all need to be more thoughtful about our expectations of others especially with remote interactions. We should love people and use technology.

How can our readers further follow your work online?

They can follow me or connect on LinkedIn and Instagram @drdinamd or visit my website site www.aglowdermatology.com

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.