Doctor APPointments: The future of medicine?

Consulting a dermatologist via an app: How did the idea for Dermanostic come about?

The great thing about it is that we didn’t specifically come up with the idea in the sense of “What can we do?” It started off with our friends, friends of friends, and family members regularly sending photos on WhatsApp to me and my friend Dr. Estefanía Lang, who would later co-found Dermanostic with me. They all had the same problem: “I urgently need help for a rash that’s developed, but I can’t get an in-person appointment.” Everyone knew we were doctors at a dermatology clinic, so they saw this route as a quick fix, and we were actually able to give most of them a diagnosis. However, that’s as far as it went.

That’s because we couldn’t issue a prescription, it wasn’t a standardized method, and the photos were always low resolution. That encouraged us to create something where anyone could contact us – and not just us, but also numerous other doctors who specialize in this field. And that’s exactly what we did.

How does Dermanostic work?

Dermanostic is a digital dermatology practice – an app-based clinic. That means it can be downloaded via the App Store or Google Play Store as you would any other app. Patients can then upload images of changes to their skin, hair, or nails for our team to assess, and our specialists will then write a doctor’s note containing a diagnosis, treatment recommendation, and private prescription. That all happens extremely quickly, usually in under 24 hours. The service is completely digital and even available on public holidays and weekends. There’s no need to book an appointment because everything works on the store-and-forward principle.

Who is your target group?

Our target group tends to be anyone with a smartphone and Internet access. Our aim was to reach people who couldn’t get an in-person appointment for whatever reason. We also wanted to reach people who aren’t mobile due to their physical health or don’t have a dermatologist within a 60-mile radius. We wanted to reach people who aren’t able to take their health into their own hands, for example residents of retirement homes or care facilities. That’s our mission. The average age of our patient group is currently between 30 and 40. We have lots of younger people, but we also have lots of older people whose grandchildren have set Dermanostic up for them. At the same time, we treat a lot of newborns, one-year-olds, and two-year-olds whose parents have contacted us. Obviously, the app primarily caters to digital natives, but it will slowly establish itself among the wider population.

What makes Dermanostic different from other apps?

First and foremost, the app was created by doctors. Second, we’ve opted for a very personal approach from A to Z. We put people front and center. We post content on Instagram and TikTok and have a real interest in educating people and interacting. Visiting our digital dermatology practice should feel cool instead of evoking that unpleasant “I’m ill” feeling. So many treatments in other aspects of life make you feel good, for example going to the hairdresser – so why shouldn’t going to the doctor also be associated with something pleasant? That’s precisely the angle we want to look at things from, in the sense of: “Hey, it’s OK that you’re not feeling great right now. We’re pleased you’re here. We’re going to look after you and get you back on track. And we’ll make it fun in the process.” And it’s that patient journey that makes us unique and sets us apart from other apps.

Speaking of Instagram and TikTok – how is digitality changing health education?

The way I see it, digitalization has meant that we can now access more comprehensive information and have complete transparency and clarity. One example from my time working at a dermatology clinic is that when patients came to us with skin problems, they would sometimes only be given a prescription rather than a doctor’s note, especially if they were an outpatient. Many of them would then go home confused, asking themselves questions like: What have I actually been diagnosed with? Am I supposed to apply this cream twice a day? Can I still go swimming? Is it safe to share a hand towel with someone? These questions were not (always) answered transparently, despite the patient being seen in person. Although, on the surface, Dermanostic doesn’t offer the same personal touch because we don’t see patients face to face, we do provide a great deal of information and give patients autonomy. For example, many write to us to say that their doctor’s note warns them that their condition could cause itching, but they’re not experiencing that symptom. We’re noticing how much attention people are paying to their diagnosis, reading their doctor’s note, doing their own research, sharing that research with us, and even coming to us prepared. I think that’s extraordinary. With that in mind, I think digitalization – when used appropriately – can be an incredible addition, and sometimes even a replacement. When combining it with in-person treatment, we can generate an unbelievably powerful synergy. There are also no time constraints in the digital world: we can help people on weekends and from the comfort of their own home. Small talk also becomes a thing of the past, and medicine becomes the sole focus. And that’s also a positive aspect for the doctors.

The app is being well received by patients, as proven by their reviews. Is telemedicine the future?

Telemedicine is the past, present, and future. I have an enormous amount of respect for the work of practicing doctors, in whatever setting. However, our system needs to change and that’s where digitalization comes in. If we didn’t need it, it wouldn’t be catching on. And we’re ultimately seeing that it’s taking hold, which is a logical progression. It’s like natural selection. For that reason, I’m going to go one step further and say that we need legislation that provides more opportunities and more scope for our services to be reimbursable, for them to be easier to access, and so that those working in the profession can one day say: “You know what, I’d also like to move to hybrid working or work from home.” And to be perfectly honest, I don’t always need to turn up in person as a patient in order to discuss a diagnosis. I think this topic will also be addressed much more intensively on a political level because a lot is currently still only covered by private health insurance or out of the patients’ own pockets.

Does telemedicine know no bounds?

Telemedicine has its limits, but everything that is externally visible can be treated well – hair, nails, eyes, and even teeth. Personally, I think it’s a shame that a holistic assessment sometimes isn’t possible in telemedicine. When a patient comes into a clinic in person, I can see a lot. How is their gait? How much energy do they have? Do they look demotivated or depressed? How are they dressed? Do they look unkempt? How do their nails look? We therefore have alternative criteria when assessing the images that patients upload. What is in the background? Does the room look clean and tidy? How healthy is the skin elsewhere on their body? What does the person’s writing reveal? Is there an undertone of aggression or despair? In short: we look out for other information to form an overall picture. And an important question we ask is: “What do you do for work?” That helps us visualize the person so that we can get an idea of who we’re actually talking to and treating. That’s really interesting because it wasn’t a factor I’d ever considered before, but it’s now become extremely relevant for us.

You’ve now treated more than 100,000 patients via the app. How does that feel?

It really blows me away when I stop and think about it. And when I think about it too much, it makes me emotional because the app has grown so much and really turned into something. I don’t know all these people, but they all know about Dermanostic. I’m so proud to be able to give back so many positives together with my team. My hope for the future is that everyone knows that we exist and that visiting a doctor via an app is a genuine option if they can’t get help elsewhere. That would be incredibly rewarding for me, although I’m already extremely grateful.