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Opinions: Techno-savvy derms: Doctors weigh in on latest technologies


Medical technology changes so often that sometimes it seems as if one hardly gets something new in the office before it's outdated and another bit of technology is on the horizon.

Key Points

Some devices make their way into a practice because they fit the physician's needs or interests, such as lasers. Other technology, such as electronic medical records, is virtually mandated to enable a medical practice to operate in the 21st century.

On Call wondered which facet of technology has made the biggest difference in dermatology practices - whether it is something the doctors use in the actual diagnosis or treatment of a medical condition, or technology used to make the practice run more efficiently. We found that in some cases, technology is combined to fulfill both diagnostic and business needs.

Dermatologists appreciate finding something that enables them to more effectively treat their patients.

Melissa L.F. Knuckles, M.D., has a rural practice in the Corbin-Richmond areas of Kentucky - even holding clinic in Hyden, Ky., a town of 200 residents. The technology she most appreciates isn't in her office, but she loves having it at her disposal. It's called Appalachian Health Extension Service (AHEC).

"When I run into a difficult case - like today, I had an interesting case of NASH syndrome and needed to find out what pruritus was associated with it - I was able to contact AHEC, and they are able to access all the medical literature and let me know what I was dealing with.

"Before AHEC came along, I would have had to drive two-and-half hours to the University of Kentucky to get textbooks, or three-and-a-half hours to Louisville to get journal articles.

"The Internet makes it easier to contact them and have them send me the journal articles. That has been wonderful," Dr. Knuckles tells Dermatology Times.

In practice for 20 years, Dr. Knuckles says her access to AHEC also means patients benefit, because they don't have to wait as long for what can be critical diagnoses.

"I had a patient the other day who had a rather abrupt outbreak of seborrheic keratosis on her back. I called AHEC to find the most common cancers associated with a related condition. They reviewed the literature, sent me the information. I called her doctor. They did a CAT scan, and she has metastatic colon cancer," Dr. Knuckles explains.

"We were able to move these things together more quickly," Dr. Knuckles adds.

Digital photography

Justin J. Vujevich, M.D., has a primarily referral practice for Mohs surgery in Pittsburgh, Pa. He finds that digital photography makes the difference in his office.

"No. 1, I use digital photography for Mohs mapping. It has several advantages over just mapping on a piece of paper. You can see the tissue you excised, relative to the orientation of the surgical defect, in one picture. It's hard to misinterpret where you've taken the tissue out, because the picture is right in front of you.

"It's also nice to show patients 'before' and 'after' photos of what they had, and what we actually had to do to take care of it," Dr. Vujevich says.

In practice with his father, Dr. Vujevich says the digital photography also aids diagnosis.

Patients who have clinically atypical moles aren't going to cut them all out. Using the ABCDE system of looking for melanoma - with E standing for "evolution" - digital photography helps show, through a period of time, which moles are changing.

"That helps in detecting which moles should have an excisional biopsy and which moles should be left behind," Dr. Vujevich says.

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