After reading the article by Morenz et al1 in this issue of JAMA Dermatology, well-intentioned dermatologists might think that they should start providing teledermatology to American Indians and Alaskan Natives. We commend the authors for exploring issues of access to dermatologic care in American Indian communities because American Indians and Alaskan Natives have rarely been studied in the field of dermatology and have experienced stark health disparities, including decreased access to subspecialty care.2,3 We draw on our experiences as codirectors of the American Academy of Dermatology Association’s Native American Health Service Resident Rotation, which includes building a teledermatology program to expand dermatologic care on the Navajo Nation, to assert that to provide effective, sustainable care for American Indians and Alaskan Natives, physicians must recognize the historical policies that have shaped American Indian and Alaskan Native communities, understand the nuances of the relationship between these communities and their health care systems, be willing to navigate the complexities of federal and tribal policies, and have a full appreciation for tribal sovereignty. Without complete appreciation for this cultural context, teledermatology is an incomplete solution for dermatology inequity seen in American Indian and Alaskan Native communities.
Kohn LL, Introcaso CE. A Cultural Context for Providing Dermatologic Care to American Indian and Alaskan Native Communities Through Telehealth. JAMA Dermatol. Published online June 19, 2019. doi:10.1001/jamadermatol.2019.0860
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