An Interesting Dermatology Visit in My Dining Room

I had to laugh at the voicemail I got before my first virtual dermatology appointment: “Hello, we are contacting you about your upcoming appointment. If you have a cough, fever, or shortness of breath or have been exposed to someone with suspected COVID-19 or traveled internationally within the past 30 days, please contact the practice about your upcoming appointment.”

My upcoming telehealth dermatology appointment

I know they have better things to do, but still, you would think that these practices would change their outreach. For example, they might have said something about the nature of the upcoming appointment. (“Hello, your dermatologist will call you or FaceTime you at the appropriate time…"). Telling us not to come into the office if we are sick is either redundant or ridiculous, depending on how you look at it. We’re already not going into the office, whether we have a cough or fever or not.

My privacy concerns about telehealth

A staff member had called previously to ask if I wanted a call or FaceTime. I said a call wouldn’t work. I wanted to show her some spots. I was surprised that they were using FaceTime. I thought it wasn’t secure and might violate HIPAA regulations. My virtual meeting with a psychotherapist is in a secure setup with a waiting room. But the staff member said that is how they were doing it. I looked it up and saw that in the face of the pandemic and the need to switch to “telehealth,” privacy rules are loosened.

Dermatology telehealth guidelines

The American Academy of Dermatology (AAD) stated that doctors could use telemedicine to treat Medicare patients “without putting their health, or your own, at risk. Telemedicine may be of particular use for patients at higher risk of infection (the elderly and those with other health issues) and for non-urgent appointments.”¹ I don’t consider myself to be elderly. But I do have underlying health issues, and I am in the older, higher risk group for COVID-19. So although I thought it was a little odd to get a FaceTime call from my doctor, I was okay with it.

The AAD statement said that in addition, doctors could use Facebook Messenger video chat, Google Hangouts video, or Skype without risking a penalty from the Office for Civil Rights for noncompliance with HIPAA rules. They should not use Facebook Live, Twitch, TikTok, or other “public-facing communication services.”¹ As an aside, I can’t imagine why they would WANT to use TikTok for a dermatology appointment.

Sharing my suspicious spots over FaceTime

The visit went okay. I had thought about putting on a bathrobe for easier access to spots on my legs than I would have while wearing my quarantine attire: yoga pants, running pants, or sweat pants. But she was uncharacteristically just on time, and so I didn’t have time to do it. (Usually, I wait for a long time in a dermatologist’s office). It was a little awkward to pull down my pants and show her some spots on my leg. But only the dog was looking.

A future biopsy?

My only concern was her comment that she might biopsy a spot if I came into the office. But since non-emergency visits aren’t happening, it would have to wait. I had already shown it to a doctor during my last trip for Mohs surgery. It is a tiny dark spot the size of a freckle. Actually, it is a little scab that never goes away. Doing what came naturally (skin picker here), I had picked at it. The first doctor who looked at it said it looked like a scab and nothing serious. Of course, I went and looked up signs of melanoma. Luckily it didn’t fit with any of those.

Comfort from the telehealth conversation

In the telehealth visit, my dermatologist’s comment about doing a biopsy at some point worried me and comforted me. How can it be both? It was worrisome because she obviously suspected it could be cancerous, but comforting because she was the second doctor who said it was okay to leave it be for now. She also reminded me to please try not to pick. Note to self: When the urge to pick arises, do something else.