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« Is Cutera violating FDA guidelines? | Main | Stock prices tumbling for laser and IPL companies. »
Saturday
Jun072008

Needed: Clinical Education Programs for Dermatology

Advocating for Better Continuing Clinical Education Programs and Clinical Exchange Programs


dermatlolgy_clinical_trainingIn the field of Cosmetic Dermatology, Continuing Clinical Education Programs are terrible and Clinical Exchange Programs are nonexistent. Who is to blame?

The big laser companies are to blame! Cutera, Lumenis, Cynosure, Palomar, Sciton and other big laser companies have not developed meaningful Clinical Education Programs and they have not encouraged or facilitated Clinical Exchange Programs. This includes Cutera’s bi-yearly Clinical Forums.

Why should they do this? Why should they put a great deal of time and resources into continuing clinical education programs and clinical exchange programs? Because clinical outcomes would be better, demand for laser treatments would increase, their customers (the providers) would do better financially (and professionally) and finally, patients would get better and safer treatments with better clinical outcomes. When the tide is higher, all boats float at a higher level. The tide (clinical outcomes) is not where it should be and this is mainly due to the laser company’s apathy and disdain towards continuing clinical education and clinical exchange programs.

We spend hundreds of thousands of dollars to purchase our lasers and then they charge us tens of thousands of dollars per year in support. They abandon us. They don’t know how to use the lasers themselves and they expect each of us to figure it out through trial and error. Trail and error on our paying patients. Yes, I am fighting mad about this and you should be too.

The correlation between clinical competence and clinical outcomes should be obvious . . . Just as comprehensive initial training gives rise to predictably excellent clinical outcomes, the ability to exchange ideas and experiences with other [laser] operators dramatically magnifies your clinical competence . . . a worthwhile clinical exchange program should utilize one or more of the following media: Online Forums, Teleseminars, Webinars and live phone support . . . as the field of [laser] therapy advances, all new clinically relevant findings and advance techniques should be made readily available to you via a continuing education program. This may take the form of a newsletter, website, DVD, Video and/or live workshop. ---The IPL Dog & Lemon Guide

How do I know there is a problem? Because I see it everyday in my practice, I talk to other providers and I read the blogs. I read how physicians don’t know how to use the Fraxel, I read how physicians don’t know how to minimize pain, I read how physicians don’t know how to prevent and treat postinflammatory hyperpigmentation. I read the blogs and I see lots of patients are not very happy with the outcomes of their laser treatments. I read the content of their complaints and these patients are not complainers, they didn’t get the results they wanted or they got a complication they didn’t want. In addition, their provider didn’t have good answers when this happened. Their providers were like “deers caught in the headlight”. These patients did not get the best treatments because their provider were not properly informed and educated about the cosmetic procedure they were performing. My prospective patients read these blogs and they don’t want to have the laser treatments because they think the treatments hurt, they won’t work or they will produce unwanted side effects.

I look around and I see very few meaningful continuing clinical education programs. I look around and I see zero clinical exchange programs other than the type we are trying to have on MedicalSpaMD.com. Zero clinical exchange programs from the big laser companies. Zero!!!

How do I know there is a problem? I have to find out about new techniques by luck and happenstance! For example, the only reason that I know that you can do ActiveFx with intervals of one month rather than 3 months is because I listened to a Webinar where this was mentioned as an afterthought. Lumenis has no mechanism or plan to keep providers informed about new techniques or thoughts. The only reason that I know you should not do Fraxel more than 3 times in a patient with Melasma is because I happened to complain about something else and the clinical educator mentioned that Reliant was receiving reports that the fourth and fifth treatments make Melasma worse. Reliant had no system and has no plan to keep its providers informed about new techniques or new thoughts. This makes me mad. When I speak to the companies about this, they pat me on the head and tell me to go away like a good boy. They just don’t get it! They tell me that I am the only provider asking to be kept informed. They try to make me feel stupid for asking questions and expecting to be kept informed. I don’t feel stupid, I think they don’t care and I think this is not smart.

They are not going to get it unless we force it down their throats. I say, “Let’s force it down their throats!” We can do this if we all politely and forcefully ask and demand these type of programs. Numbers will get their attention. When some companies do it, the others will do it because they will be able to use it as a marketing tool.

If you agree with me, please contact your laser company (your local sales representative, the person who runs the Webinars and the Corporate Vice President in charge of Marketing and Education) and ask for meaningful programs in the next 6 months at the lastest. Tell them how disappointed you are in their performance so far. Tell them that you would not recommend their lasers to another physician because they don’t have clinical exchange programs and continuing clinical educational programs.

All they have to do is put out a monthly Newsletter and put up a Discussion Bulletin Board on the Internet for their clients. They should also publicize and promote the use of the Newsletter and the Bulletin Board. They should provide expert moderators who contribute to the discussion. They also should summarize or transcribe all of their Webinars and Clinical Forums so more physicians have access to this information (without having to sit at a computer for 2 hours each time to view a marketing Webinar). Each Webinar and Clinical Forum should serve as a “discussion springboard” off of which a Discussion Bulletin Board with Expert Moderator is launched.

If you would like these things, contact your laser company today. If they pat you on the head and give you excuses about why they can’t do this or won’t do this or why they don’t think it is important, send them a copy of this website and let them read this entry. Tell them they can do it now or do it later. Tell them they can do it the hard way or do it the easy way. Tell them the view never changes unless you are the lead dog. They want to be the lead dog on this issue.

Reader Comments (6)

Fantastic commentary CHMD!

You are absolutely on point that the laser companies (or at least many of them, I haven't dealt with all of them) don't see the connection between making this ridiculously expnsive machine do what it is supposed to do by developing protocols and guidelines and the likelihood we will go back to them for additional equipment needs. I have been reading the Cutera old bull/young bull thread and have to agree with many posts that there has been essentially zero support after the purchase. When we complain thatt the results are not what was 'PROMISED' when we bought the equipment, we are told we can get those results if we just spend more money. What other industry gets away with selling something this expensive and having no responsibility for outcome? Auto manufacturers have lemon laws that they are subject to. Even real estate has appraisals and inspections and mortgage underwriters to ensure the value of the investment. What do laser providers get? Brochures with before and after photos that I don't even use anymore because they don't approach reality. Published guidelines that are liability driven and are so underpowered as to be pointless, leaving the provider to experiment on their own. Every time I turn the power up on a patients treatment to get better results, I say a little prayer that this one won't be the one that comes back with horrible PIH.

The one saving grace in all this is that the lack of in-depth effective training and clinical education after purchase on many of these systems will probably change as pressure is put on the market due to the economy, and from aftermarket brokers who often arrange for their own training. If you can buy a machine for $50K rather than $100K and still get training by someone who uses the machine in real life and is not on the payroll of the manufacturer, why not?

I applaud the folks who squeeze every ounce of effectiveness out of their equipment, and over time we have developed much more useful protocols than were given to us by the laser companies, but I would ask the question: considering all the effort and trial and error you have put into getting to the point where you are getting close to the results you want, wasn't that where you expected to be the day they devlivered the equipment?

Forums like this are invaluable, and I wholeheartedly agree that the laser companies should welcome open clinicl discussion and debate about their products in the same way that university level 'thinkers' welcome debate about their ideas. My father always told me - if you aren't ready to present your work for scrutiny, you shouldn't make any claims about it.

06.8 | Unregistered CommenterDermaDoc

My first laser was a used Epilight. As I could afford it, I purchansed the Vasculight for the Nd:yag head. My business is in a small city and I couldn't begin to pay off a new machine costing over 100K when I started. With both of these machines I received two days of training with telephone support for a year. I feel I am competent in the usage of these lasers. (Incidently, my two competitors that bought their lasers new are out of business).

I did purchase recently a new laser which was over 100K and I got one day of training and telephone support if I can reach my rep... However, if I need them, I am in the middle of a surgery! The company doesn't have any webinars or educational meetings. They have been working on setting up shadowing with another physician doing the procedure, but I have had the machine for 6 months. When I do use the machine and have a suboptimal outcome, they say it is your technique, you will get better. Well, I sure would like to know the correct technique the first time! I pride myself in doing a good job for my patients.

It is frustrating that physicians can't get together and talk more freely on the web. I think if this website would be exclusive to just physicians by some method of giving proof that we are licensed physicians, the exchange may be more open and forthright. Besides going to conferences and talking to other physicians inbetween the lectures, there is very little education on how to use our lasers. I often look online to find information and this site is the closest I have come to getting straight answers. Since I am not a dermatologist, I often wonder if I would be allowed on some of the Derm websites, if I would get answers there. Since I have the new laser I find that I am treating patients conservatively so as to not cause harm, but I have to ask myself, did I do the best job I could have done?

PacificiWestDoc,

Make some noise with your laser company. Send them a copy of this post. If we all stand up and scream and yell and throw temper tantrums, maybe they will pay attention. If just one company pays attention, they will have a competitive advantage and soon all will be following suit.

So stand up and be counted. Make some noise!

What they are doing is JUST NOT RIGHT. Let's demand change.

In the meantime, stay engaged on this blog. It is moving in the direction of being a place for "Clinical Exchange"

06.9 | Unregistered CommenterJEE

Why we need the laser companies to help us:

1. They get all the info funneled to them (good and bad). Knowing the good and bad helps us all learn faster. Once they get this information, they need to communicate it to all their users. No one else can do this.

2. They know who has their lasers and light devices. It is hard to find other users unless the companies facilite this. We want to communicate with other providers who have the same laser and light device. We want to know each other's successes and failures so we can learn from each other

The laser companies are still AWOL when it comes to clinical exchange. All they care about is money and not provider's interests or patient interests. They are too stupid to realize that if they make their treatments better and safer they will make more money. These companies are run by idiot marketing a holes. Just talk to a few of their executives.

Most of them will be out of business soon because their lasers don't work, they are too dangerous, their providers don't know how to use the lasers and the providers don't know how to avoid and treat complictions.

The laser companies are run by idiot executives. They are just like the executives on Wall Street. They are going to s c rew us all and hope to walk away with golden parachutes.

We need to hold their feet to the fire NOW. We need to annoy them to death if they don't support and encourage "clinical exchange". Contact your laser company today. Ask your rep what they are doing. Contact the VP of Marketing and Sales. Contact the CEO. You can find their contact info on the company website.

10.24 | Unregistered CommenterDr. Poed

paste this link into your browser for a great article on clinical exchange:

http://healthy-aging.advanceweb.com/Editorial/Content/Editorial.aspx?CC=189732

12.12 | Unregistered CommenterCHMD

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