Latest Updates from Camden Dermatology & Mohs Surgery
"As a native New Englander, it is a privilege to be able to practice in a part of Maine where the
tremendous demand for dermatologic care surpasses the availability of highly-trained, board
certified dermatologists. I hope that my joining CDMS enables more rapid access to both
essential and elective skin care, which patients might have formerly waited months to receive.” - Dr. Huerth
This year has brought more than its fair set of trials to our practice, our region, our state, our nation and our world. I feel such a sense of loss as I am sure so many of us do with regard to the natural order of our lives and our activities. As challenging as it has been crafting a plan for our practice and our patients, I cannot imagine the burden which presently rests with our educators contemplating the safety of school staff and our children amidst the chaos that is COVID-19. I pray that as the school year opens in a very unconventional way, that our community will remain healthy and continue with the dedication to safety we have demonstrated all along. I would like to also offer my sincerest appreciation for the large number of cards and well wishes I have received over the last month. Some of you may be aware that I had to have a total hip replacement at the very end of July and as a result I have been out of the office for the month of August. I remain extraordinarily grateful to Dr. Alise Curry who once again provided phenomenal care to our patients in my absence. It is not always easy for physicians to address her or his own health care needs, but it was clear that I was at my functional limit. Having experienced what it is like to attempt to work through excruciating chronic pain, my heart goes out to those who cannot find relief. I remain ever grateful for the extraordinary care I received from Dr. Tom Mitchell at Pen Bay Orthopedics as well as Dr. George Babikian at Maine Medical Partners Orthopedics for their remarkable skill in helping me through this incredibly difficult time. I cannot recommend them highly enough. 🍃🌾🍂🍁 Things are beginning to fall back into place for us at Camden Dermatology & Mohs Surgery as well, and most excitingly we will have a new dermatologist joining us very shortly (to be covered in a separate post). After a very comprehensive search, I was also thrilled to hire a new operations manager who began with us this month. Please welcome Dave Largen to the practice. Dave joins us from most recently serving as Manager of Spruce Point Inn in Boothbay Harbor for many years. He is excited to make the transition to serving patients and our staff with the same level of pride and courtesy that is customary in the hospitality industry. With so many things occurring all at once I never got to express my formal appreciation for the service and dedication shown by both CC Hayden and Brittany Kenniston over the past two years. CC has relocated back to her home state of Connecticut to be closer to family and Brittany had a wonderful opportunity to be full time with her family's business. We miss them both very much, and wish them every success. We are looking to make changes to our patient flow including transitioning back to having an in person front desk assistant as well as a highly controlled, socially distanced waiting room environment so you can expect to hear more about this coming soon. Thank you again to our patients for all your understanding in these last very difficult months.
So much has transpired since late March! April saw us trying to keep up with patients primarily via telederm and very limited in office contact with primarily Dr. Lavigne and later with Sam Cohen, PA-C. As we began to resume our surgeries and other necessary procedures as time passed, we have refined our protocols to meet all necessary safety assurances. We are working to resume our normal capacity however, there remain limitations. We are still electing not to use the waiting room and when you arrive to your visit, you will be directed to call a virtual number to speak with Danielle or another one of our dedicated MAs who is serving as our virtual front desk attendant. She will notify our staff of your arrival. As the weather gets warmer, please ensure that your vehicle is equipped with A/C . We will do our best to run on time, but with some delays in care related to COVID, some visits may take longer than normal and while we have hired additional staff, we are cannot operate at the highest capacity due to safety considerations. Once notified, our in-person MA staff will come to the front door to retrieve you and escort you back to the exam room. All patients are requested to wear a mask to her or his visit. Please notify the staff if you are in need of one. If you do not desire to wear a mask, we politely request to reschedule your visit to another safer time. We cannot make any exceptions to this policy. Other safety questions which have come up recently include: How are you keeping me safe during my visit? All surfaces are cleansed and wiped after each visit including door handles, tables, chairs, exam lighting, counters and accessories such as mirrors and dermatoscopes. Has Dr. Lavigne, Sam Cohen, PA-C or any of the staff been tested for COVID? To date, no provider or staff member at CDMS has been exposed to COVID, nor has any staff demonstrated any worrisome clinical symptoms. In keeping with standard screening protocols, in the absence of exposure concern or illness, there is no indication for COVID testing of office staff or providers. Will someone be taking my temperature? If you have health concerns, please check your temperature at home. The office does have a contact-less thermometer if necessary. How are staff performing hand hygeiene? I n times past, we would typically use hand sanitizer to cleanse our hands going into and out of every room and in the exam room as indicated. Given the significant effectiveness of hand washing relative to control of COVID, we have revised our internal protocols to require all staff to wash her or his hands for a minimum of 20 seconds with soap & water upon entering each exam room, every time the room is entered. During the time staff are within the room, hand sanitizer may be used as indicated and all staff will sanitize their hands upon exiting the exam room. All staff have been counseled as to the indications for additional soap & water washing when needed during the course of the day. Will staff be wearing gloves at all times? We take infection control very seriously at Camden Dermatology & Mohs Surgery. Gloves are an essential part of personal protective equipment and are to be worn at any point there is contact with open skin, surgical wounds, sutures etc. For routine examinations gloves are not necessarily needed depending upon the nature of the area being examined and staff may not deem it necessary to wear gloves for other routine portions of a visit. If you have questions, please feel free to ask Dr. Lavigne, Mr. Cohen, PA-C or our MA staff at the time you are being seen. We will always do what is best for your safety as well as the safety of our staff, but it is also important to determine when protective equipment is indicated, as we want to be the best stewards of these supplies.
Camden Dermatology & Mohs Surgery will remain "open", but with significant changes and protections. Please review the following information closely & carefully for details. Tonight at midnight all non-essential businesses in Maine are subject to closure for at least 2 weeks time. Medical practices like Camden Dermatology & Mohs Surgery are exempt from this mandate, although I assure you nothing is business as usual. I have made a promise to my staff to protect them, their health and the health of those closest to them, and with this commitment in mind, I am relocating all my staff to work from home, excluding myself. This is a challenging endeavor which requires us switching to a internet based phone system, moving computers, creating and refining workflows. If you call the office between Wed, March 25 to Friday, March 27th and are unable to reach someone directly, please leave a message with the voicemail system (Klara) we have in place. These messages can be retrieved virtually by my staff who can attempt to reach you back in a rather timely manner. I will continue to see very specific appointment types (detailed below) in the office with significant advanced coordination as I will be working with my staff in only a virtual fashion from their respective remote locations. We will not for example have someone at the front desk nor will I have MAs assisting me in person in the exam room. The American Academy of Dermatology has issued the following recommendations regarding how to classify types of visits which may require in-person evaluation and we are electing to apply these to our workflow: A visit which will decrease the chance that a patient with a severe dermatologic condition would need to seek care in an emergency room as this would contribute to unnecessary burdens on a portion of the system which is already struggling. As an aside, I obviously take great pride in the work that dermatologists do and unlike Jerry's opinion famously expressed in a long-ago Seinfeld episode, there are actual dermatology emergencies. Its not always just about putting aloe on it :-) A visit which will decrease the risk of a poor outcome such as progression of a high risk skin cancer, risk of metastatic disease, monitoring for melanoma or other serious condition. A visit in which an urgent biopsy is indicated or other urgent therapeutic intervention is indicated. I would add that I will continue to see suture removal/post-operative patients, complex wound checks which cannot be performed in a telederm setting, and any urgent concerns directly referred to me from primary care physicians or other medical providers in the community for either new patients or existing patients. Encounters for focused concerns such as pre-cancerous lesion management, ongoing follow ups for certain concerns such as acne, psoriasis, eczema and preliminary screening of specific "worrisome lesions" shall be rescheduled as teledermatology encounters. Our experienced dermatology PA, Mr. Sam Cohen will be available two full days a week to facilitate teledermatology encounters and Dr. Lavigne will also be providing this service as well on a yet to be determined basis. Given the decision by Gov. Mills, we are choosing to reschedule all Mohs and excisional surgeries for a minimum of two weeks . These procedures require at least the presence of medical assistants, and I do not believe it is appropriate to put my staff in this situation. We had previously made the decision to reschedule all cosmetic encounters when directed to do so last week. Telederm Visit Details We are fortunate that our communications system Klara has made it relatively easy for those with the following to have a telederm visit: Either a smartphone type cell phone (Apple or Android will work) or a laptop/PC with microphone & camera capabilities Strong internet connection or WiFi service (be aware of any restrictions in your calling plan if you elect to use cellular data) Iphone users will need to have Safari browser as the active browser; Android users will need to utilize a Chrome browser Shortly before the visit, situate yourself in a quiet, private, well lit area for ideal communication If you are using a laptop/PC, you will need to go to the following website: patient.klara.com At the time of the telederm visit, you will receive a text message prompt to your cell phone: "Dr. Lavigne / Sam Cohen, PA-C started a video visit with you." Please follow the link to join now: https://klara.com, etcetc You can also join from your computer by going to patient.klara.com You will then be asked to verify your date of birth. Once this is completed, you can join the video encounter. (Please be sure to click "allow permission" for Klara to use your microphone and camera as this is fundamental for the telederm visit.) We will be documenting the details of the encounter within our electronic medical record as well as to process prescriptions. Policies related to billing and reimbursment for teledermatology/telemedicine visits were modified last week for Medicare as well as Medicaid, and numerous commercial insurers are offering expanded telemedicine serivces. Please understand that these visits will be processed similarly to in-person visits and degrees of coverage may vary depending upon your carriers policy. It remains to be seen at this time how long we will need to operate in this fashion. However "DON'T GIVE UP" as we will all do what is absolutely necessary to continue to take excellent care of you, our patients as well as to preserve the health & wellness of our staff. Special Note As an independent medical practice, I operate just as other small businesses do, and we share similar concerns related to ongoing operations due to the financial impact of this dreadful situation. My ability to ensure the preservation of jobs for my staff, fulfilling my own family's needs as a more or less single income household and to support the other business we depend upon daily is reliant upon the successful adoption of primarily teledermatology encounters by our patients at this time. I wholly understand that it may be new and somewhat cumbersome to consider initially, but it is my hope that with the resources we have at hand, we can make it a successful bridge to the other side of this devastating situation. I am very grateful for your ongoing support, patience and understanding during this stressful time.
On Thursday March 12, 2019, Maine CDC notified the state of the first case of confirmed coronavirus. We had been fortunate in the preceding weeks to have remained one of the last New England states to see the arrival of this very scary, highly contagious disease. As I write this post on the evening of Tuesday March 17th, the number of Maine cases has increased to 32, with one specifically confirmed case in Knox County. I would like to assure our patients that we are doing everything within our power to keep our patients and our staff as safe as possible. I will be routinely posting very timely information to the Camden Dermatology & Mohs Surgery Facebook page to keep the public updated as to our protocols and if necessary any closures. Following a staff meeting on March 16th, we are asking patients to heed the following recommendations & protocols : * Please SELF-SCREEN before your visit. It is very important to call the office to reschedule your appointment if you or a close contact or family member has been unwell, specifically upper respiratory symptoms and fever. * In an effort to practice the recommended "social distancing", we will ask patients to come into the office to acknowledge that they have arrived for their appointment. Please share your vehicle information (make & model) with our front desk staff and then we will ask that you r eturn to your vehicle to wait until an medical assistant will signal to you. We believe that this procedure will help reduce the chances of unintentional exposure by eliminating congregations of patients in the waiting room. * We are evaluating options for transferring routine visits to a telemedicine platform and will be contacting patients shortly about this option. For our Mohs patients: * We are fortunate to have a large number of Mohs treatment rooms. With this in mind, we politely request that patients being seen for Mohs bring only one companion with them to the visit. We will have both the patient and the patient's companion wait in a dedicated treatment room and not in the common waiting room. This is again designed to limit the potential exposure through larger groups of people. * We have chosen to suspend our coffee, tea & snack service in an effort to limit potential contamination sources. So please bring a Thermos of your favorite beverage and snacks from home to keep you comfortable. We will be able to offer patients water upon request. * We have also made the decision to remove all reading material from the waiting room as we felt that these magazines & books represented an unnecessary point of possible contamination, so please bring reading materials, laptop or Ipad with you for entertainment. I recognize that this is an ongoing and evolving situation on a day to day basis. There are many factors for me to consider as both a physician, self-employed business person with a staff of over 10 people as well as a mother and wife. I give you my assurance that we will continue to strive to meet our mission statement of providing our patients with the highest quality medical care. Please remember to visit Camden Dermatology & Mohs Surgery Facebook page for the most up to date information on a day to day basis. You may find the Facebook link at the bottom header of the website. Thank you for your understanding and cooperation during this difficult time.
Please join me in welcoming Sam Cohen, PA-C to the practice. Sam is a very experienced dermatology focused physician assistant who joined our practice in early November. He has been working specifically in dermatology since 2013. He will be seeing adult and pediatric dermatology patients within the practice currently on Fridays. Given the access issues that are notable in underserved areas like our own, it is our hope to continue to provide timely care for our current patients and potentially expand our capacity to care for new patients as well. Dr. Lavigne will be providing supervisory expertise as a board certified dermatologist in an indirect and direct manner as clinically indicated.
I know I have a tendency to brag on my staff, but I feel incredibly fortunate to have been able to start this practice with such an amazing group of assistants. As most of you will understand, starting a medical practice these days has its challenges. One of those is keeping a balance between the best service and managing costs. If we had unlimited resources, I think an in-house call center would be ideal. Then all calls could be answered by a LIVE person, a REAL human being on the line with you in REAL time. But presently I have an amazing assistant Jessica who answers (or tries to answer!) every call. Let me tell you, Jessica is awesome. She is kind, through and communicates more clearly than almost anyone I know. She is a machine when it comes to taking calls. But clearly she is one person (although often she does the work of many more). So what happens when she is helping schedule an appointment and someone else calls? More often than not, the second call will go to voicemail. It is our goal to have all our assistant staff checking the voicemail logs regularly in order to respond in a timely fashion. But alas on busy days, this system can lead to frustration and the anticipation of playing another round of phone tag just gets daunting. Well, we have finally landed on what we hope is an ideal solution. Type "Hello" to Klara. When coming to the website, you will find a new nice little blue box in the lower right hand corner of the screen with the prompt, "Message Us". Clicking this box will open up a channel to allow for HIPAA secure messaging straight to our support staff at the office. Using the vast power of technology, our office can more easily distribute these HIPAA secure messages to any available staff member to respond in a much more efficient manner, and wait for it, you can even upload a HIPAA secure photo if needed! Thanks for your continued support of Camden Dermatology & Mohs Surgery!
Whether you and your family celebrate Hanukkah or Christmas, this season marks a time of year to be conscientious for our blessings. Over the past nine months, our little practice has grown and triumphed over numerable challenges, such as unexpected snow days (right after opening), sickness (personal, familial & staff!), hiring and training new assistants as well as the well-deserved retirement of my amazingly talented Mohs technician Sandy this past Fall. When we started in March with a backlog of hundreds of calls of patients anxious to establish with our fledgling practice little did we know that we would be temporarily closing Dr. Lavigne's schedule to new medical dermatology as our registered patients exceeded 2,200 in only a short 6 months. All of this would not have been possible without countless blessings, and of course hard work from everyone involved, plus a little patience from you all, our patients. I have long been a proponent of the adage, "Let go & let God". This philosophy reminds me that blessings can come in the most unexpected ways. I pray that you and your family may have both anticipated and unexpected blessings this holiday season. Thank you for all your support and encouragement! Happy Hanukkah! Merry Christmas! We wish you a joyous time with family, friends and loved ones, and BLESSINGS for health, happiness and prosperity in the new year. ~ Dr. Lavigne
It is hard to believe that we are coming up to our 5th month anniversary!!! We are extremely proud of our accomplishments to date, and we will continue working hard to refine our processes and ensure every patient has a wonderful experience. I would like to take an opportunity to praise the most dedicated start-up staff with whom I have ever had the fortune of working. The staff of Camden Dermatology & Mohs Surgery is the backbone of the practice and their efforts are amazing. It has been the mission of Camden Dermatology & Mohs Surgery to place a priority on compassion , ethical integrity and putting patients first . This means that patients are always central. I am pleased that we will have some good news in the near future as we look to grow in serving our patients and to continue to revolutionize the dermatologic care available in Mid-Coast Maine.