Teledermatology Before, During, and After Covid-19: A Vital Tool to Improve Access and Equity in Specialty Care

Since the onset of the COVID-19 pandemic, telemedicine has rapidly expanded across the nation as medical systems have had to shift to providing care through virtual modalities to ensure the safety of patients and staff. Teledermatology, in particular, is wellsuited for telemedicine, with literature supporting its efficacy, equitable quality and accuracy, and cost-effectiveness in comparison to in-person visits. Teledermatology holds great potential in continuing to increase access to patients and ensuring continuity of care, particularly for those from rural and underserved areas. Although introduced decades ago, the adoption of virtual visits has previously been limited by restrictive coverage policies, lack of reimbursement, and maintenance costs. While the Centers for Medicare and Medicaid Services and most private payers have ensured broad coverage for telehealth since the start of the pandemic, many of these policy changes are temporary and set to expire at the end of the public health emergency. Continued advocacy efforts and future studies highlighting teledermatology’s impact, particularly on minorities and underserved patient populations, are critical for long-term legislative changes to occur and to provide coverage to our most vulnerable patients. In this article, we highlight the state of teledermatology prior to the pandemic, the legislative changes that permitted teledermatology to rapidly expand during the pandemic, and the importance of continued coverage after the pandemic

Margarita de Sossa, Sixteenth-Century Puebla de los Ángeles, New Spain (Mexico)

Margarita de Sossa’s freedom journey was defiant and entrepreneurial. In her early twenties, still enslaved in Portugal, she took possession of her body; after refusing to endure her owner’s sexual demands, he sold her, and she was transported to Mexico. There, she purchased her freedom with money earned as a healer and then conducted an enviable business as an innkeeper. Sossa’s biography provides striking insights into how she conceptualized freedom in terms that included – but was not limited to – legal manumission. Her transatlantic biography offers a rare insight into the life of a free black woman (and former slave) in late sixteenth-century Puebla, who sought to establish various degrees of freedom for herself. Whether she was refusing to acquiesce to an abusive owner, embracing entrepreneurship, marrying, purchasing her own slave property, or later using the courts to petition for divorce. Sossa continued to advocate on her own behalf. Her biography shows that obtaining legal manumission was not always equivalent to independence and autonomy, particularly if married to an abusive husband, or if financial successes inspired the envy of neighbors

Health policy literacy among U.S. dermatology residents: characterizing past experiences and future goals

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with non-clinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success

Health policy literacy among U.S. dermatology residents: characterizing past experiences and future goals

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with non-clinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success

Telemedicine and the battle for health equity: Translating temporary regulatory orders into sustained policy change

At this moment in the United States, we are battling two of the largest public health crises of our time: the COVID-19 pandemic and systemic racism, which has existed for centuries but recently came into sharper public focus. In tandem, these public health crises mean that the COVID-19 pandemic has placed a disproportionate burden of disease incidence, hospitalizations, and deaths on our most vulnerable communities. As medical professionals, there has never been a more important time to systematically address health equity in policy and practice

A 53-Year-Old Male with Relapsed Diffuse Large B-Cell Lymphoma on Chemotherapy with a New Leg Lesion

Patients with underlying malignancy who develop new skin findings while acutely ill often require skin biopsy for histologic evaluation and/or culture to reach a diagnosis. Here, we present the case of a 53-year-old male with relapsed diffuse large B-cell lymphoma on chemotherapy who developed new skin lesions on the leg. On exam, there were 2 nickel-sized, erythematous to violaceous round plaques with central necrotic cores on the right lower leg with relatively nonspecific clinical features for which the initial differential diagnosis was broad. Consensus on a diagnosis was reached upon histologic evaluation of his skin biopsy in the context of his clinical setting. This diagnosis led to a change in treatment plan, with subsequent clinical improvement