Telehealth Best Practices: Dr. Mark Scott Brown of Oculo-Facial Consultants On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Use telehealth to ensure patient-doctor dialogue remains consistent

While some patients might be hesitant to visit the office during the COVID-19 pandemic, this does not mean that it is okay to put their care on hold. Telehealth allows patients to continue their routine care and stay consistent with their management and treatment for serious eye conditions that are often best treated early in the disease progression, like TED.

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. Mark Scott Brown, M.D.

Dr. Brown is a board-certified ophthalmologist, specializing in Oculoplastics and treats diseases such as Thyroid Eye Disease (TED). He is board-certified by the American Board of Ophthalmology and a member of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS). Dr. Brown is one of only two oculoplastic subspecialists with this level of training on the Mississippi Gulf Coast and is highly regarded throughout the Southeastern United States.

Dr. Brown graduated from Harvard College (Biology, cum laude), and Tufts University School of Medicine, and also completed his medical internship at Mount Auburn Hospital, A Harvard Teaching Hospital, Boston, MA. His residency in ophthalmology was completed at New York University Hospital, Manhattan V.A. Hospital, Bellevue Hospital, New York City, NY, while his fellowship in ophthalmic plastic and reconstructive surgery was completed at the University Illinois Chicago & Michael Reese Hospital, Chicago, IL.

When away from his work, Dr. Brown enjoys walking with his dogs, scuba diving, photography and is a Scoutmaster with the Boy Scouts of America.

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?

I got started in my career through a family friend, Michael Patipa, who worked in oculoplastic surgery and allowed me to shadow him when I was a teenager. I didn’t initially set out to be an oculoplastic surgeon, and I was torn between business and healthcare. Healthcare eventually won, and Michael became a colleague.

Can you please give us your favorite ‘Life Lesson Quote’? Can you share how that was relevant to you in your life?

“You don’t know what you don’t know”

The process of choosing a career path is so difficult and abstract until you have seen or experienced things. How can you know? I did not know I would choose to specialize in ophthalmology and would be focusing on the eyeball out of the entire human body. I even went on to become even more specialized and focus on the orbit and the eyelids. There is no way I could know this starting out, but found my way once I started learning and experiencing.

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?

I must thank my mentor, Dr. Allen Putterman, for helping me get to where I am in my career today. Dr. Putterman is a world leader in oculoplastic surgery and training in Chicago. When I was matched to his fellowship, I knew it had a reputation as being one of the most difficult fellowships to survive. Although Dr. Putterman had a very strict personality, he was a phenomenal role model in showing me how to run a practice and effectively work with patients. It was a grueling yet rewarding year, and I know that I, as well as every other fellow who trained underneath him, am better because of it.

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 a 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?

Although telehealth has been immensely helpful during the COVID-19 pandemic, there is still an art of medicine that is not transferable through telehealth. You cannot replace the in-person experience, from shaking someone’s hand to getting to know someone personally, there’s something special about an in-person visit. I take the time to walk my patients out to the door after every exam, and it is amazing how important that interaction is to them.

Despite wearing a mask and other PPE in the office, patients can still experience the interactions and banter I have with my staff members when they’re in the office. We are a close team that enjoys a good laugh, which puts the patients at ease. This is particularly important for patients I’m seeing with serious, vision-threatening eye conditions like Thyroid Eye Disease. This can be a scary time and they need to trust the team taking care of their most precious function: their sight.

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?

While we have been able to simulate many of the vision tests virtually, as well as diagnose patients with TED and other conditions, there is a limit on how many measurements we can do over the screen without being able to physically touch a person’s eyes.

Another issue we run into is that some of our patients do not have the best internet access, so the telehealth video conference calls tend to freeze up, making it harder to interact with the patient and effectively communicate. But like everyone, patients, even our elderly, have adapted. In fact, many of my patients take the telehealth appointment from their car for the best service.

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. Ensure there is a low barrier of entry for patients to embrace telehealth. It can be complicated for patients to install a new app and create a username and password for telehealth visits. When looking at the technological options to integrate into our practice, we decided on a software platform that allowed patients to join the visit through their text messages, simply clicking ‘accept’ to join the teleconference. We’ve had a near 100% success rate with this method, even with our 85-year-old patients.
2. Practice the virtual processes to ensure a seamless experience for patients. Once you decide on a software platform, take the time to explore and practice how it works with your staff to ensure the patient has an easy, seamless experience. We recreated the experience a patient would have in-person, just virtually. The patient starts in a custom “waiting room” with our office logo, then interacts with a member from our front desk, followed by a visit with our technician and myself. We all join from separate locations but for the patient, it is as seamless as if we are all together.
3. Take advantage of the opportunity to show and tell. When doing eye exams over video teleconference, we’ve been able to assess visual acuity and color vision by putting eye charts on the screen and asking people to read what they see from a particular distance. We can also check motility of the eyes by asking patients to look up, down, left and right directly into the camera. But most importantly, when test results or scans come in, we do more than just talk patients through them. Using our webcam, we show them the scans so they can see firsthand what we are reviewing, just like they would in an office.
4. Assess when you need to accelerate care. Telehealth has allowed us to continue regular follow-ups with our patients, which is particularly important for people with progressive conditions like TED. We are also no longer constrained to office hours so we are continually “open” for evaluations, post-operative follow-ups and emergency video calls, whereby we can easily determine if the situation has escalated and in need of an emergency visit to our office or the hospital.
5. Use telehealth to ensure patient-doctor dialogue remains consistent. While some patients might be hesitant to visit the office during the COVID-19 pandemic, this does not mean that it is okay to put their care on hold. Telehealth allows patients to continue their routine care and stay consistent with their management and treatment for serious eye conditions that are often best treated early in the disease progression, like TED.

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?

With telehealth, we are able to see patients who live farther away and might not otherwise travel to our practice. Not only is this a huge time saver, but it expands access to specialized care for more people in need and gives patients more decision-making power. With telehealth, they can meet with different doctors to see who’s right for them and assess how that practice is organized. A good sign of office culture? How the practice has embraced and adapted to telehealth to continue working with patients.

Telehealth also enables increased safety for our patients. It minimizes the number of times they must come into the office amid the COVID-19 pandemic as well as reduces potential travel risks. This especially helps the patients we see who are diagnosed with TED. TED symptoms can include enflamed eyes and double vision, which makes it a risk to drive. We can ensure their care is uninterrupted via telehealth.

Lastly, a major benefit of telehealth visits that traditional in-office visits cannot provide is the added layer of personal experience that the physician and patient get to experience by getting a “look” into their home lives. When conducting some telehealth visits, I will often invite my dog to join the visit. The patients enjoy seeing this human aspect of their doctor.

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?

One of the main components that helps facilitate telehealth effectively is platform compatibility between Apple and Samsung. We also learned that a lot of software systems typically operate via email invite, which is not ideal for older patients, especially those who don’t check email on their phone. We chose doxy.me whereby patients receive a text message with a link to their appointment. They simply click and are entered into the visit.

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

A telehealth platform that doesn’t require internet connection!

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?

When it comes to telehealth visits, patients should know that there is no downside. It presents zero health risks and it is ultimately an opportunity to talk with your doctor, or alternatively, get to know a new doctor and their staff to help decide if you want to become a patient at their practice.

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 particularly intrigued by the new tools that have the capabilities to take virtual eye measurements, enhancing the remote experience of care I am able to provide for my patients. Additionally, it is exciting to see virtual reality experiences that allow others to feel what it is like to live with eye conditions, like TED. Learning about the effect of eye conditions like TED is important for both patients and caregivers. These types of virtual reality tools are helpful because it lets you see firsthand the serious effects certain rare diseases can have on a person’s life.

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

While telehealth has allowed us to stay close with our patients, and expand access to specialized care for new patients, I worry that the art of medicine is at risk without the personal relationships and trust built in-person. Telehealth is more transactional and there is a limit to how much doctors can confidently do without physically seeing a patient. While effective, efficient and convenient, I wouldn’t want telehealth to ever fully replace the in-person visit. There is room for both in this “new normal.”

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.

The pandemic has increased tensions and people tend to have shorter tempers, which makes customer service difficult. Many patients are quick to argue about wait times, wearing a mask, or restrictions on family members being able to come back to the office or room. It’s important to remember that we’re all trying to do the best with a situation that is out of our control. Everyone is on a learning curve and we are going to get through this together.

In the meantime, be kind and pay it forward. And when it comes to telehealth, trust that you can and will adapt. We all can use technology with a little practice and it’s essential to keep our health in check.

How can our readers further follow your work online?

They can go to https://www.facebook.com/watch/?v=988001554983034