key: cord-0698486-pyfds2gv
authors: AlAbdulkareem, Ahmad
title: Palpation in dermatology, will COVID‐19 be the last straw?
date: 2021-01-11
journal: Dermatol Ther
DOI: 10.1111/dth.14759
sha: 32e29209f412a35714381672b6f97da210767038
doc_id: 698486
cord_uid: pyfds2gv

nan

The routine practice of dermatology has been undergoing a paradigm shift under the impact of the ongoing COVID-19 pandemic. After an initial halt of services and occasional redeployment of the dermatology workforce to help manage overwhelmed medical wards, the dermatology outpatient service has largely returned, yet changed profoundly. 1 Telephone and video consultations-teledermatology-are becoming the norm, and neoplastic pathologies have taken precedence out of fear of backlogs. Teledermatology, with its fans and critics, therefore has gained ground.

While the COVID-19 pandemic poses significant practical challenges to the outpatient practice of dermatology (and medicine more broadly), dermatology is more uniquely positioned in that it is heavily visual. Dermatologists can, and often do, simply look at lesions, identify a rash, reach a diagnosis, and offer management.

The obvious omission of touching a patient may have been permitted, or accepted at best, but it is now very much expected. With the majority of consultations happening remotely, and asymptomatic carriers posing a potential risk to clinicians, minimal patient contact is the new norm.

On the one hand, this will likely fast-track the overdue allocation of funds and the needed provision of teledermatology services with all the benefits it offers. On the other hand, teledermatology has its many pitfalls too; of particular interest, the ramification it, compounded by the COVID-19 pandemic, will have on physical examination. 2 As the necessary teledermatology clinical framework is perfected and agreed upon, many current trainee dermatologists and residents risk a diminished clinical skillset and an inadequate experience. 3 This trend of shortcutting the occasionally ritualistic physical examination has actually been observed since pre-COVID-19 times, and probably more so in dermatology than elsewhere. 4 However, the ongoing pandemic has accelerated it, if not made it the default. This raises the question of whether the physical examination, particularly palpation for dermatologists, will be yet another COVID-19 causality.

Palpating lesions is an often underappreciated modality that may sound obsolete to some but it actually affords dermatologists significant extra diagnostic cues. 5 Importantly, and where appropriate, touching also conveys support, empathy, and reassurance, fundamental cores of the humane practice of medicine that ought not to be overlooked. Times are indeed changing, new technologies are replacing the old, and the routine practice of dermatology is evolving; while it is important to incorporate teledermatology into routine services and to prepare trainees accordingly, it is also critical to safeguard clinical skills, and to uphold their validity and diagnostic accuracy. Clinical skills should not be a dying art.

Data openly available in a public repository that issues datasets with DOIs.

A very peculiar practice: dermatology in the era of COVID-19

Will the traditional physical examination be another casualty of COVID-19?

Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemic

The lost art of clinical skills

Palpation of the skin-an important issue