A Team-Based Model for Efficient PDT Delivery

In a recent conversation with Dermatology Times, Michael O'Donoghue, MD, outlined a pragmatic, team-based approach to integrating photodynamic therapy (PDT) into a busy general dermatology practice. His model offers a practical blueprint for clinicians seeking to expand field therapy for actinic damage while maintaining clinic efficiency and patient satisfaction.

O’Donoghue, who practices in the Chicago metropolitan area and northwest Indiana, emphasized that successful PDT implementation begins with workflow design. In his office, PDT is assigned to a dedicated treatment room shared with laser procedures. Importantly, PDT visits are scheduled under the medical assistant (MA) template rather than the physician’s schedule. The physician’s direct involvement is limited to focused tasks, such as lesion preparation and application of the photosensitizing agent, typically totaling 5 to 10 minutes. The MA manages patient intake, incubation timing, blue light exposure, and much of the education process.

This delegation structure allows PDT to function as a streamlined, multi-step protocol without disrupting physician throughput. Initial appointments are staggered at 30-minute intervals, with return times coordinated around the incubation period, usually 90 minutes to 2 hours. By standardizing these intervals and centralizing responsibility with trained staff, the practice minimizes delays and scheduling bottlenecks.

Beyond logistics, O’Donoghue underscored that patient communication is central to treatment acceptance and adherence. During the initial consultation, he frames PDT primarily in terms of long-term risk reduction—specifically decreasing the likelihood of future nonmelanoma skin cancers in patients with significant actinic damage. Written materials reinforce this discussion after the visit, when patients may better process the information. Insurance verification and follow-up calls from staff provide an additional layer of reassurance and logistical clarity.

Notably, he is deliberate in how he addresses discomfort. Rather than foregrounding pain, he describes treatment-related discomfort as a biologic signal of therapeutic effect—damaged cells responding to light activation. While not minimizing the experience, he contextualizes it in terms of benefit. During illumination, an MA remains in the room to provide real-time coaching and distraction, a step he considers essential for patient tolerance and completion of therapy.

Post-treatment expectations are also clearly defined. Patients are counseled to anticipate several days of erythema and downtime, typically manageable and self-limited. Repetition of these expectations—during consultation, scheduling calls, and the treatment visit itself—helps reduce anxiety and after-hours concerns.

For dermatology practices managing high volumes of actinic keratoses, this structured, communication-driven approach highlights how PDT can be delivered efficiently without sacrificing patient-centered care.