The Art of the Virtual Consult

Just six months ago if you surveyed aesthetic and anti-aging practitioners and practices around the world, it is likely a majority would have said they don’t find virtual consults a necessity to running their business. But in just a few short months our world has changed drastically, with virtual consults not only proving invaluable to staying connected to current patients, but also helping many practices actually grow their patient base during the shutdown. However, there are those that already realized the potential of virtual consults, even before the pandemic, to save time, weed out price shoppers and moreover, remove geographical limitations.

Let’s start with a case study (name and patient details have been changed a bit for anonymity):

Bill was tired of looking tired, and worse yet, “too old.” He retired from a suc- cessful business career only to learn that retirement wasn’t for him. He wanted to revitalize himself to reenter the market, this time as a consultant. But, at the age of 67, he realized he was at a bit of a disadvantage. He would be competing with more youthful men and women. In the COVID-era, he couldn’t count on his face-to-face personal charisma to get him work. He had to get much more comfortable with his image on video.

A lifetime of yo-yo weight loss, unprotected sun exposure and genetics had left him with the “Ds:” dyspigmentation, deflation and descent. Bill hated the way his sagging lower face and neck looked. He wanted to appear more energetic, youthful and dynamic.

Bill asked his wife to discretely get him some recommendations from her aesthetic-knowledgeable friends. He did a Google search for “Do I need a facelift?” He looked at the websites of five plastic surgeons near him and two others outside his geographic area. He scoured the doctors’ before and after photographs as well as their reviews. After a month of deliberation, Bill decided to book a virtual consult with a remote physician in San Diego, Calif. He settled on a virtual consult with Steven Cohen, MD of Faces+.

Bill filled out the basic information on the Faces+ patient portal. The office was able to schedule him for an early morning Zoom appointment the following week. Dr. Cohen was joined by his aesthetic consultant for a free, 30-minute exploratory meeting.

“I really felt comfortable with Dr. Cohen,” Bill noted. “The doctor was upbeat, polished and incredibly straight forward. He seemed to know almost every question I had in mind. He told me about the length of the procedure, and that there would be almost no bleeding. I learned that for the neck men seem to heal a bit faster than women due to a difference in blood supply. It was good to know that there were no drains and that most patients could get by with mild pain relief. He listened and allayed my concerns. He also went over the concept of stress relaxation of tissue, and reassured me that this very rarely happened, but if it did and things got too loose, he would fix the issue without charging for his services. Best of all, he let me know that I would still look like me only a lot more youthful.”

After answering a few more questions about diet and nutrition, Dr. Cohen left the room and his aesthetic consultant asked Bill if he wanted to go over the costs for the procedure. Bill asked that she email the details. Bill booked a lower face and neck lift for the end of the month.

This actual case study was meant to highlight the most common aspects of virtual consults in a real-world setting. If you are considering moving more of your consultations and follow-ups online, you probably have many questions. To make it easy, the key points have been organized into five Ps: Preparation, Process, Performance, Payment and Platform.

Preparation

When the pandemic hit, Julia Ward, MD, a functional and aesthetic medicine practitioner in Sugarland, Texas was prepared. She’d spent the past ten months honing her video skills, going so far as to learn to write and read short scripts from a tablet teleprompter using the PromptSmart app, setting up a dedicated space in her office to perform her videos and developing a variety of videos such as “Welcome to My Practice” and content targeted at specific populations: women with menopause, men losing their vibrant edge, and more.

“We have had our best months during the pandemic,” Dr. Ward expressed. “The good news is we were deemed an essential service and could stay open, but we had built strong digital rapport with not only our patients, but also prospects. We do quite a bit of advertising on Facebook so all of these patients met me on video, thus there was a sense of comfort and familiarity. For me, getting comfortable on camera was a natural segue into doing more telehealth.”

Like Dr. Cohen, Dr. Ward also offers a free 30-minute consult. While both clinicians vastly prefer in-patient consultations, the virtual consult has helped with their pipeline. Dr. Cohen’s practice was closed for three months, but at the time of this article, he has been open six weeks and is now, “very busy.”

Process

Practitioners who have embraced the aesthetic tele-consult speak to the efficiency of the process; however, it is a process that cuts both ways.
Patients no longer have to drive to multiple doctors. They can shop multiple practitioners and get a great deal of free advice from the comfort of their home. Similar to the live consult, it is important to have processes in place that allow the practitioner to identify patients who are more likely to commit to treatment.

Suneel Chilukuri, MD, an internationally recognized dermatologist based in Houston, Texas, has a practice – Refresh Dermatology – that could be the subject of envy. Prior to the pandemic, Dr. Chilukuri hadn’t admitted new patients since 2016. As the pandemic changed patient flow, he adapted to identify more of the types of patients who would be a good fit with his practice.

He expanded his virtual consults with the caveat that, “I don’t want to be shopped. I want someone who is going to commit to me as I am committing to them.”

Dr. Chilukuri has his aestheticians start the intake in separate rooms. He staggers the consult from room to room, usually taking five to six minutes per patient.
For those patients who seem to be a good fit and want to proceed with a live consult, he puts them on a skincare regimen prior to the first visit. He typically recommends a retinol, topical vitamins C & E and a sunscreen. Products are delivered to the patient overnight and the team follows up with one more virtual visit two to three days later, then weekly follow-up until the live appointment.

According to Dr. Chilukuri, there are several advantages of following this process. “Those who choose not to purchase products probably aren’t a good fit for the practice. When they come in for a live consult, the first session is complementary. Since they have already been on the skincare regimen, they already trust us, and they know what we can do for them.”

Dr. Chilukuri finds that patients are often more engaged on the virtual consultation, and he can often pick up on the little clues that are the hallmark of his high-touch personalized service. “With the virtual consult, you get to see what people are like at home. I did one consult in which the guy was on his fishing yacht. We sent him a Bass Pro shop gift card along with his products.”

Performance

Just as you would spruce up your office before greeting a new patient in the flesh, you’ll want to do the same thing with your video appearance. This means:

• Tidying up the background for your consult.
• Making certain you are well lit and the room is quiet. Many practitioners will use a ring or halo type light or LEDs to even out their coloring.
• Consider making an investment in a Logitech camera and a USB Blue Yeti microphone to get the best picture and sound. Tip: try putting a pillow or two in back of your free-standing microphone to dampen the sound from room reverberation.
• Be happy and grateful. Even if the subject of your consult is serious, you want to come across as happy and grateful that the prospect or patient has decided to spend time with you.
• Attend to your appearance: this might mean taking down the shine on your forehead, nose or chin. Especially if you are close up on camera, eye drops can improve the appearance of dry, red, itchy or watery eyes.
• Use your listening skills and body- mirroring skills. Appear thoughtful and reflective when the patient is speaking. Mirror their body language. Lean in just a bit when you are discussing a key point.

Payment

If you run a pure cash-pay aesthetic or functional medicine practice you are already free from the complexity of billing insurance companies. Conversely, if your practice is heavily dependent upon in-person procedure revenue, the pandemic has proven quite costly. It is one thing to keep your name and brand alive in the marketplace, anticipating an uptick in live visits. It is another to find some revenue sources to tide you over. This is where online product sales can provide a bit of a bridge.

Online product stores can allow practitioners to determine which products they want to carry and make available to their patients. While the profit margins with online stores are smaller than products dispensed in-office, the trade-off is more than made up by the convenience of not having to hold inventory, worry about dated product, ship or deal with returns. And, when patients are no longer coming to the office, they can still purchase your recommended professional products through your online store.

There is a great deal of emphasis being placed on the need – or opportunity – to “pivot your practice.” COVID-19 provides this opportunity through greater adoption of the virtual consult. You may also benefit from adopting two other strategies: Embracing the concept of skin health and beauty from inside out (hence supplements/nutraceuticals), and to the extent you feel comfortable, providing some guidance on recommendations for immune support.

Dr. Ward recently created an online store using GetHealthy.store. The company supports her branding; they also allow her to offer skincare, lifestyle products and private label in addition to professional nutraceuticals from the major manufacturers.

Platform

In medicine, we know that systems drive efficiency. Getting the right system in place can greatly facilitate your virtual practice. While some practices choose to communicate with free services such as Zoom, Facetime, Google Meet or doxy.me; others are taking advantage of greater integration by adopting a more comprehensive approach.

Symplast is a full-bore EMR tailored to the aesthetic marketplace. Their platform serves as the backbone EMR for several thousand plastic surgeons, medspas and dermatologists. It provides all the necessary features to efficiently run a practice: online patient booking, texting, scheduler, digital intake, e-sign consents, e-prescrip- tion, financials and accounting and more. While the desktop supports virtual health consults and allows for robust video uploading, the company has taken the next step in providing convenience and ease of use to both physician and patient by extending desired features to their app.

The Symplast app allows for collaborating. The practitioner can annotate and share data right on the app. There is full multimedia capability. Financial transactions can also be done on the app. Patients can receive estimates, approve and sign, and the patient coordinator receives a popup notice.

Facundo Formica, CEO of Symplast points to one added advantage: privacy. “Nothing is stored on the practitioner’s device. All information – including photos – goes directly into the cloud. You never have to worry that a family member might stumble upon patient photos if they access your mobile phone.”

Another system used by many aesthetic practices is TouchMD. Their system is built on GoToMeeting and facilitates the virtual consult. Using the TouchMD app, the patient can upload HIPAA compliant selfies – three photos taken at different angles. And, the TouchMD drawing tools can show how the patient would look with fine line/wrinkle improvement, reduction in submental or body fat. Consents and approvals are also handled over the app.

Panacea, Part-Time Solution or Peek into the Future?

The virtual consult is not a panacea, but aspects of virtual dialog will remain and grow even after the pandemic. Lori Robertson, MSN, FNP-C, owner of Skin Perfect Medical in Brea, Calif., readily admits she’d rather have patients come in. Addressing the virtual consult, she noted, “There are so many things I can’t see well, either because of the lighting, or the short focal length of the camera on the patient’s device. On the other hand, we’ve moved all of our post-visit consults to virtual. In that situation, I can just as easily evaluate the post-op from a fractional resurfacing procedure, or determine whether the patient needs to come in for a neurotoxin touch up.”

Nothing can replace hands-on treatment with an aesthetic device or an injectable. No matter how good your on-camera presence, the virtual consult still lacks all of the intimacy and personal touch of the live moment. But for today, and a host of tomorrows, gaining mastery of this medium may well determine the health of your practice.

About the Author

Mark J. Tager, MD
Dr. Tager is CEO of ChangeWell Inc., a San Diego-based company that coaches and trains practitioners to enhance their presence in person, on camera and online. Dr. Tager directs the practice management tracks for the Vegas and Miami Cosmetic Surgery conferences. His latest book (with Stewart Gandolf, MBA) is entitled Cash-Pay Healthcare: How to Start, Grow & Perfect Your Business. He can be reached at team@changewell.com and IG: drmtager.