Study Shows that Smart Phones Can Help Skin Docs Consult on Patients in the Hospital

One of the things I’m learning is how to best describe scientific research in simple terms. Below is piece I wrote about a new study from some of my Penn Derm mentors that was just published in JAMA Dermatology:

Doctors consulting using a smartphone “app” might be just as good as an in person visit from a doctor, according to a new study from the University of Pennsylvania. Many patients in the hospital end up with skin problems but most hospitals don’t have dermatologists to evaluate them.  A possible solution may lie in a an “app” that lets doctors look at pictures of the skin problems and tell hospital staff whether or not the patient merits an in person visit.

 The study, published Wednesday in JAMA Dermatology, took 50 patients from the Hospital of the University of Pennsylvania who needed to be seen by a dermatologist. Researchers took a picture of the skin problem using a smartphone and sent it virtually to dermatologists (“teledermatologists”) who provided an opinion. Another dermatologist saw each of the patients in person and recorded his decision: did the patient really need to be seen that day, the next day, sometime during their hospital stay or could it wait for an outpatient visit? He also wrote down whether the patient needed to have a biopsy (skin sample).

When the in person dermatologists decided a patient be seen the same day, the teledermatologists agreed in 90 percent of cases. And they agreed in 95 percent of cases where the in-person dermatologist had recommended a biopsy. The doctors completely agreed on a diagnosis 82 percent of the time, and partially agreed in 88 percent of cases, which is the standard variation expected between doctors.

This is encouraging news in a time when many areas of the United States have very little access to dermatologists. “In addition to addressing physician shortages from a clinical standpoint, teledermatology programs are very important for vulnerable citizens in the United States and abroad,” said Dr. William James, author in the study and past president of the American Academy of Dermatology. “It is wonderful that the impact of these teledermatology consultations continues to expand.”

Journalism roundup

IMG_8285It’s been strange to be out of the clinical world for this long. Sometimes I find myself striving to remember the name of a disease or drug that would have been second nature to me last year. On the other hand, it’s been great to look at medicine from the outside in – it’s given me a perspective that is hard to achieve when you are mired in the thick of it.

Here are some pieces that I’ve recently published. Any thoughts, suggestions and comments are welcome!

  1. Flu shot story + podcast/slideshow
  2. An opinion column on the Affordable Care Act (aka “Obamacare”) and medical students
  3. Cost containment in dermatology. I got to interview the president of the American Academy of Dermatology! 
  4. Local forum on the Affordable Care Act
  5. Superheros at the children’s hospital!

In case you missed them: there are also a few pieces that I published while in IndiaIMG_4202

  1. Living with leprosy
  2. Unhealthy eating in college campuses
  3. Leprosy in the modern world

Tanning and Skin cancer on the Rise

Among white women of college age, one in three visited indoor tanning salons in 2010 according to the CDC.

Oh my pale skinned ladies! What is becoming of us? I thought that the one upside of that whole “Twilight” thing would be a resurgence of appreciation for porcelain skin. Alas, it looks like indoor tanning continues to be a scourge that will take more than hormonally crazed vampire fans to overcome.

This is a really important message and one that seems to fall on deaf ears. I think that it can be very hard for young adults to delay gratification for an abstract gain later in life. We are, after all, the YOLO (you only live once) generation (shudder). Even aesthetic reasons aren’t compelling: “I don’t care if I look like a prune late in life” is a response I get when informing adolescent patients about the consequences of sun exposure. And cancer risk? It hardly seems relevant and gets filtered out with the rest of the fear-based assault by the media and heath professionals.freckles

Despite efforts from many dermatologic organizations and dedicated sunscreen wielding parents (we call my mom sergeant sunscreen), the incidence of melanoma (skin cancer) has increased fourfold since the 1970s for women under 40. Egads!

I don’t know what the answer is. Before I left, I was trying to start a program at my med school where med students and resident physicians would visit sorority houses and answer their questions about skin care etc with an emphasis on sun/UV safety, specifically indoor tanning. For example: many people feel that a base tan is actually protective- what they don’t realize that any suntanned skin is de facto sun damaged skin. In this way, we could treat these college students like the adults that they are and simply answer their questions without shoving information down their throats. Plus, I think that having people close in age might make the message feel a bit more palatable and relevant. But in truth, I don’t know what the best methods are for this intervention.

And I won’t pretend that it’s limited to women in adolescence or very early adulthood. In fact, I am hardly a role model of great sun protection. Even with all education and dedication to dermatology- I too have fallen prey to forgetfulness when it comes to sunscreen: witness my freckles on the right hand side. But I continue to try to be vigilant in my crusade against the sun’s harmful rays even while enjoying my time in India and Thailand. And I’ve learned to accept my paleness- it’s what makes me who I am. Meanwhile, I will try not to sigh every time I see someone’s comment on a friend’s facebook photo: “you look so tan and healthy!”

Weekend in Gujarat

I spent the weekend in Vadodara- which is in a state called Gujarat (southwest of New Delhi). I came to stay with Dr. Verma- an esteemed Indian dermatologist who has many connections to Penn. He and his amazing family were so welcoming, kind and  accommodating. From street food to fine cuisine- they fed me so much Gujarati food that a) I’m still full and b) I should get checked for pre-diabetes (Guarati food is known for being sweet). They also showed me around, allowed me to attend dermatology clinic and even clothed me in my first sari!

While at dermatology clinic, Dr. Verma told me that there is a severe shortage of dermatology coverage in India, especially for rural areas. One reason for this coverage gap is that most dermatologists (and other speciality docs) are in cash only private practice. Villagers simply cannot afford it. I also learned that a common practice model is having purely walk-in clinics- which means that patients don’t have set appointments. When I asked him why he did this, he replied that his patients rarely show up on time for appointments- a phenomenon he deemed “Indian Standard Time”

Below are some pictures from my visit to this beautiful city.