Dermatology 2.0: How the internet is changing us, our patients and our practice (Preprint)

UNSTRUCTURED The internet, in a short span of time relative to the history of modern medicine, has changed us doctors, our patients and our practice. This article reviews these changes and how they have occurred. The write- up was conceptualized after the author, a private practitioner in a tier 2 city in India, started seeing subtle and overt differences in the consultation and treatment paths of patients who were internet savvy vs. those who were internet naïve. A survey was conducted in the clinic to study the behavioral changes brought about by the internet among patients of clinical as well as aesthetic dermatology. It must be remembered that these changes are completely new to the practice of dermatology; even small numbers of positive replies are noteworthy. The Covid 19 pandemic started while this article was being written, making teledermatology a requisite of the time, rather than an option. Our dependence on technology has never before been so profound. As modern day dermatologists, is important for us to be updated about the interactions of dermatology and technology. We must constantly try to optimize the benefits of the internet and minimize its pitfalls. Needless to say, most of the facts mentioned here have been gleaned from the internet itself, from a wide range of sources including but not limited to medical journals, books, news reports, commercial websites and magazines.

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Some studies of tonsillectomy outcomes have low response rates to mailed quality control questionnaires. This study evaluated the effect of nonresponders to mailed questionnaires about posttonsillectomy complications by determining whether mail responders and nonresponders differ. Questionnaires were mailed to patients 3–6 weeks after tonsillectomy to assess postoperative complications, defined as contact with a private practitioner and/or hospital readmission related to postsurgical bleeding, pain, or infection. Nonresponders to the mailed questionnaire were interviewed by telephone 7–11 weeks postoperatively, and responses of mail and telephone responders were compared. Of 818 patients undergoing tonsillectomy during the study period, 66.3% responded by mail, and 29.5% were interviewed by telephone, for a total response rate of 95.7%. The mail response rate was significantly higher among parents of pediatric patients than among adult patients (71.4% versus 58.7%, p<0.001). In the pediatric group, overall complication rates were 65% higher among mail responders than telephone responders (20.9% versus 12.7%, p=0.049), likely due to their higher rates of both visits to private practitioners and infection, as there were no differences in rates of pediatric readmission, bleeding, or pain between the responder groups. Among adult patients, mail and telephone responders did not differ with respect to their overall complication rate (40.9% versus 34.1%, p=0.226) or their rates of readmission or bleeding. However, similar to the pediatric group, visits to a private practitioner were slightly more common among adult mail responders than telephone responders (30.6% versus 21.1%, p=0.065), as were reports of pain (p=0.001) and infection (p=0.006). Studies relying on mailed questionnaires with low response rates likely overestimate the rate of minor complications handled outside the hospital, but rates of major complications involving readmission are unlikely to be seriously biased by low response rates. Supplementing mailed questionnaires with telephone interviews may increase the validity of surgical outcome studies.

A Personal Reflection on the 50th Year Anniversary of the Optometric Historical Society

Personal reflections of Dr. Lester Caplan, a founding member of the Optometric Historical Society, on his involvement during the course of his life and his career as a private practitioner in Baltimore, MD, as an academic at the University of Alabama, and his leadership in public health optometry at the local, state and federal level.

Basic Bookkeeping and Accounting for the Private Practitioner

Running a practice with sound financial management practices is not as complex as many believe. The concepts require basic math skills and the establishment of an infrastructure that provides an awareness of what is happening financially in the business. Ways of approaching common business decisions about purchases, leases, managed care contracts, and accounts receivables are discussed. Basic bookkeeping and accounting systems are described. Common accounting terms and financial reports, such as profit and loss statements, are defined and described. Budgets, practice “dashboards” for consolidating practice data, and safeguards for loss prevention are described.

Is Private Practice for You?

This chapter provides useful guidance on the nature and characteristics of private practice in the mental health professions. Unique features of the private practice setting, differences from other practice settings, and the personal characteristics the practitioner needs to be happy and successful in private practice are discussed. Essential features of private practice are explained, the roles a private practitioner will serve in are reviewed, and different practice models and options for the business entrepreneur are described. Pros and cons of private practice are reviewed to assist the reader in making an informed decision about the appropriateness of choosing a career as a private practitioner. Recommendations are provided for what one may do while in graduate school and after graduation to prepare to be a successful private practitioner. Resources and suggested readings are provided to further educate the reader on private practice as a career option.