Feature | Jul/Aug 2015

Online Consults: The Future is Now

Could online interactions pre-visit pave the way for better in-office experiences?

Is there such thing as a “typical” cosmetic patient anymore? Why?

Dr. Breslow: I think the typical thing about cosmetic patients is that they are not typical. There are a bunch of different kinds of cosmetic patients. Some cosmetic patients know exactly what they want. They come in to your office, they know what they want, and they just schedule something right away.

There are the patients who don’t know what they want. They are information seekers and trying to figure out what they want. There are the shoppers who know what they want, what they need; they are just trying to figure out the best price. Some patients are very easy to deal with, some patients are less easy to deal with.

Especially for dermatologists or plastic surgeons or facial plastic surgeons, the practitioners who deal with both medical patients and nonmedical patients, you really have to know which kind of patient you are dealing with, because they definitely are different.

Could you talk about what we know about what cosmetic patients are doing online?

Dr. Breslow: As far as what we know about cosmetic patients online, this is an evolving industry. Think back to where the Internet was 15 to 20 years ago versus where it is now; and then consider how the advent of social media changed the aesthetic medicine landscape. For the younger generation everything is now done online. I know that there are studies done that the younger generation doesn’t even want phone calls; they just want to do everything online. There is so much information that’s available online now that to some extent it is a double-edged sword: It is great because you can get any information you need but there is also information overload.

How do prospective patients sort through the information? That’s what the doctors are trying to determine. How do cosmetic doctors make themselves relevant and get across to the patients—these new younger and more savvy cosmetic patients—what they can do for them? There are reviews, before and afters, there are Twitter, Instagram and Facebook posts and all these different ways that the doctors are trying to get this information to patients.

It has also been shown that a lot of potential cosmetic patients look at online reviews holding the same value as a word-of-mouth reference because it is a similar value to them.

The Internet has demystified plastic surgery and cosmetic surgery. Now more and more people know about it and it is less of a secret, and the Internet has made the interaction between the patient and the doctor much easier. You don’t have to go into a doctor’s office anymore to find out what you can get. Also with the advent of noninvasive procedures, lasers, injections, a lot of noninvasive technology, patients are now finding ways that they can make themselves look really good without having surgery. So as far as what people search on the Internet, they are looking to see what options they have in terms of getting the results that they want. It is not just more information, it is more relevant information, it is more of what the patient is looking for, it is trying to connect getting the patient specifically what they are looking for, because not every patient is the same.

What is it that cosmetic surgeons are looking for in their patients? What are the things that might be important to the cosmetic surgeon?

Dr. Breslow: As far as what we are looking for in patients, I don’t think that I am necessarily looking for any particular thing attributed to a patient. A better way of looking at it is what we are trying to avoid. We want patients who are serious about having procedures, and most patients who come in to your office are serious about having a procedure.

The conversion rate for cosmetic doctors on average is less than 40%, and the reason is not because these patients are coming in to your office to waste your time. The reason is because the patients may not know what they want and then they come in thinking they want one thing and then when you tell them that they need something else they have basically wasted your time and their time. Or patients know what they want or are just going around multiple doctors to find out what the cost is going to be. There are some patients who just doctor shop because they want to see which doctor they like the most. Again there is a whole range of reasons why they end up not having the procedure and it is not necessarily that the patients themselves are trying to make the consultation not work out.

Remember: 90 percent of all cosmetic patients are women, most of the women have jobs or children or both and they don’t have time to go around from doctor to doctor to find out which procedure is the right one for them. So it is a waste of their time, as well. So from both the doctor’s perspective and the patient’s perspective what they both want is to find the right match as quickly as possible and as efficiently as possible and not waste each other’s time.

Tell us about Zwivel, what it is, and how it address consultation challenges?

Dr. Breslow: The consultation process in cosmetic medicine is extremely inefficient. As I said, less than 40 percent of all cosmetic consultations result in a procedure being performed, and that’s a huge waste of time for both the patient and the doctor. So this was something that I had experienced.

I came up with the name Consultation Conundrum—that the patient and the doctor have to actually waste their time going through with the consultation to find out that it was a waste of time, because the factors that contribute to wasting your time aren’t usually apparent at the onset of the consultation. This is a very frustrating inefficiency, and I was pretty sure that I wasn’t the only one who is experiencing it.

Zwivel was built on the idea that there is a way that you could add and create an efficiency to a currently inefficient system—similar to Match.com. You still have to go out on a date with the person, you just want to find out if this is a date worth going out on. It doesn’t mean you are going to end up marrying he person, but you want to know if you are even a compatibility match.

So we looked at contributing factors in a consultation that are important. What the patients concerns are, their interested procedures, their photos. They can record a video of themselves, they could put down their budget, it is all optional, they don’t have to put down a budget if they don’t want to, but if they want to let the doctor know the budget it is just a way of giving them information. It is all HIPAA compliant, it is all private and secure between each patient and each doctor.

The patient can, from the comfort of their home or from where they are on their iPad or their phone or their computer, check off their concerns and their desired procedures and upload photos and their budget and record a video and search for multiple doctors who, based upon reviews and rankings and proximity and board certification status, and send this request to all these doctors. The doctors can look at it and each give their preliminary opinions and say whether the patient is a candidate for this procedure, the cost, and other information. The responding doctors cannot see each other’s responses, but the patient does and the patients can therefore make an informed decicision before they come in. They still have to come in for the full consultation, before they come in they could see if this is more likely to end up being the doctor that they want to have the procedure with.

In a strange way I am as happy when the patients go through the process and they end up not coming in as when they do come. Because the Zwivel process takes me about three or four minutes, whereas an in-person consultation on average takes 45 minutes to an hour. So I can very quickly respond to them saying for example, “You don’t need this procedure, I think you need this procedure.” And they say, “Thank you, I am not interested in having that procedure,” and they don’t show up. But I just saved myself an hour of time; I saved them an hour of time. When the patients do come in after this, the conversation rate is significantly higher, because they already know pretty much what I am thinking.

This is not live video chatting. This is asynchronous. The request gets sent as a package to the doctor that shows up in a doctor’s inbox and the doctor can look at it and review it and the doctor sends back the patient a packet of information that they could look at and decide at that point whether or not they want to come in.

Additionally, there are filters on the site. If you sign up for Zwivel and you create your account, you can actually filter out for the procedures that you do; If you don’t do anything on the body or the breasts, only the face will show up. So a patient can’t even connect with you for anything other than what you do. If they try to it would say this doctor does not perform the procedure you are requesting.

Doctors who are interested in learning more can go to www.zwivel.com, watch a video on how it works and sign-up for the free service. Additionally, we are about to launch a premium service that offers a higher ranking in the search tool and also offers doctors enhanced “Reply” features, including the ability customize their replies, invite their staff to participate in their replies, and to save previous replies to use again in the future.

Gary D. Breslow, MD, FACS, Founder and Medical Director of The Breslow Center in Paramus, NJ is Co-Founder and CEO of Zwivel Online Cosmetic Consultations, an online platform that is transforming the way cosmetic patients search for and connect with cosmetic doctors. He spoke with NewDermMD about the challenges of cosmetic consults and the possible role of online interaction to add efficiency and increase patient and physician satisfaction.