Vol. 31. No. 3


“Technology is a useful servant but a dangerous master,”
said Christian Lous Lange, a recipient of the 1921
Nobel Peace Prize.1 This statement is as true today as it
was then. As physicians, we must leverage technology
to improve the quality and efficiency of patient care, not
to replace good medical decision making. We must
make technology our “servant”, not our “master”.
Information technology (IT) can “serve” physicians in
many ways. It can help us take advantage of the vast
body of literature available to make well-informed decisions
based on the latest “best practices.” It can help
us be more efficient. Efficiency may come from the ease
and rapidity of accessing patient data from an electronic
health record without the waste of storing vast amounts
of paper charts and expending a great deal of manpower
to organize and search among those charts. Efficiency
may also come from using tablets to quickly show patients
a library of before and after pictures relating to
their upcoming procedure. These, and many more examples,
are available in this issue of Seminars in Cutaneous
Medicine and Surgery.
The common thread of nearly all of the IT tools we
use in medicine is that they help us to record, manage,
organize, and/or recall information. These duties are
increasingly relegated to technology rather than to humans.
In fact, in this age of information overload, IT is
a necessity, as managing the vast amounts of patient
and medical data is nearly impossible.
Today, we see more patients daily than were seen by
doctors 50 years ago, and because of legal and billing
reasons, we need to document so much more with every
visit. At the same time, the medical literature is growing
at an unprecedented rate, making it nearly impossible
to keep up. In 2011 alone, there were over 25,000 new
articles indexed in PubMed related to the skin. Over
6600 of those related to skin cancer.2 One must read
18 articles a day, every day of the year, just to stay
abreast of the indexed skin cancer literature, and that
number keeps growing. This does not include the nonindexed
body of literature, such as textbooks and nonindexed
journal articles. These facts make a strong case
for tighter integration of technology, specifically IT, in
our specialty.
The medical field is adapting by training physicians
to use IT to handle the onslaught of information. Early
in their careers, medical students and residents are being
armed with computers, tablets, and mobile-phone–
based information resources. They are starting rotations
with electronic health record systems and learning to
access needed data in an electronic format. With this
foundation along with learning tools, such as teaching
videos for every procedure, virtual dermatopathology,
e-books, and countless “apps” for reference, they will
thrive in a world of information overload. It will be
almost as important to weed out and quickly find the
information that you need as it is to have a solid base of
medical knowledge.
Patients will also adapt to new ways information is
exchanged between the patient and physician, but there
will be challenges. Just as the transition from physicians
who made house calls to office-based practices required
a fundamental change in consumer philosophy, the
transition to teledermatology will not come easy. However,
it is already proving to be an efficient way to
perform preliminary diagnoses and triage true dermatologic
urgencies versus benign conditions. For several
years now, we have received pictures on our mobile
phones from emergency-room physicians, primarycare
doctors, as well as from dermatologic colleagues.
These electronic “curbside consults” help prioritize and
better use our valuable specialty care appointments.
This is just one iteration away from receiving the “consults”
directly from patients.
The last decade has brought tremendous technologic
innovations and advances to dermatology and dermatologic
surgery. Within this issue, you will find many of
these new tools and how they can change the way you
interact with patients, interact with other physicians,
and how you practice medicine. However, don’t forget
that IT is no more than a tool. It is not a substitute for
knowledge and good medical decision making. As the
health care provider, you have the primary responsibility
of weighing in factors of a patient’s current state,
mental or physical, to render a decision. The IT tools
today cannot be a substitute for human decision making.
Therein lies the art of medicine, which no technology
can take away from us; at least not yet.

Dermatology Resources on the Internet

Brent D. Wainwright, MD, MSME | Dean D. George, BS

information. Today’s Web enables features that facilitate information sharing in a social and
collaborative manner, thus transforming the way we access data and communicate with our
patients and colleagues. The visual nature of the field of dermatology lends itself to the use
of the Internet for reference and educational purposes. To generate a list of Web sites
commonly used by academic dermatologists, the authors polled the Accreditation Council
for Graduate Medical Education Dermatology Program Directors for their top 3 Web
resources. The purpose of this article is to identify resources used by dermatologists as
well as patients and examine factors that can influence Internet search results. Concerns
regarding professionalism in the era of social media are also explored. As the volume of
health information on the Internet continues to increase, it is essential for physicians to be
aware of what is available in cyberspace. Reference and learning tools for the physician,
learning and support tools for the patient, and physician Internet presence are key aspects
of modern dermatology practice.
Semin Cutan Med Surg 31:183-190 © 2012 Elsevier Inc. All rights reserved


Clinical Photography in the Dermatology Practice

Peter J. Lebovitz, BS, MBA | William K. Witmer, BS

Photography has been accepted for decades as a standard means for documenting dermatologic
conditions and as an adjunct to their treatment, in both medical practice and
research. The emergence of low-cost easy-to-use digital imaging systems has made
good-quality photography more accessible to practitioners, while providing improved functionality
in the clinical environment. Primary concerns are controlling lighting and positioning
to provide a clear record of the patients skin condition and maintaining consistency
over time to assure meaningful comparison of clinical end points.
Semin Cutan Med Surg 31:191-199 © 2012 Elsevier Inc. All rights reserved.


Expanding the Role of the iPad and Tablet Devices to Cosmetic Patient Consultations

Ashish C. Bhatia, MD | Jeffrey T.S. Hsu, MD | Jing Wang

The iPad is a useful reference tool for patient education in cosmetic consultations. In this
article, we plan to (1) discuss how the iPad can be implemented and used by patients and
physicians in consultations, (2) compare the advantages and disadvantages of the iPad
with other forms of technology, (3) discuss the optimal way of using the iPad for patient
care, (4) see how this tool complies with privacy regulations, and (5) look at other uses of
the iPad in the patient care setting. There has been positive feedback from both patients
and physicians regarding the addition of the tablet computer during consultations. In
addition to showing patients pictures of cosmetic procedures, the iPad also has various
multimedia capabilities such as videos and drawing tools that are useful in optimizing patient
satisfaction, increasing clinical efficacy, and improving the overall patient experience.
Semin Cutan Med Surg 31:200-202 © 2012 Published by Elsevier Inc.