Telemedicine is a new branch of medicine that utilizes the Internet to connect patient and doctors, often over long distances. Dermatology is one area where telemedicine has been used extensively. However, a study just released analyzing telemedicine for skin disease in the United States showed that many of these “for profit” websites are delivering substandard care.
These websites ask visitors to email digital photographs of their skin condition, and then usually within a day, a doctor looks over the photographs and sends back a diagnosis and in many cases prescribes treatment. These sites in the USA charge anywhere from USD 35 to USD 95 (R$ 125 to R$ 340) per virtual “visit” and the patient pays by debit or credit card.
In the study just published, researchers from the University of California (San Francisco) invented 6 fictitious patients with 6 different skin conditions, and sent the photographs of their condition to 16 different for-profit teledermatology websites. The conditions varied from psoriasis, to secondary syphilis, to melanoma skin cancer as well as more benign conditions such as acne.
Then the researchers analyzed how accurately the 16 teledermatology websites diagnosed the conditions and if they prescribed the correct treatment. The researchers were overall not happy with the results.
While a majority of diagnoses were correct, there were many incorrect diagnoses, and many of these were because the doctor did not ask for the details of the patient’s history. The patient’s story if often as important as actually looking at the patient’s skin lesion, but two-thirds of the sites did not ask for the patient’s complete medical history, and only about half of the female patients were asked if they were pregnant.
None of the websites correctly diagnosed the patient with syphilis manifesting as a skin rash, because they did not get the patient’s full history. Regarding the fictitious patient with melanoma, 3 out of 14 thought the lesion was benign, when in fact, melanoma is a serious malignancy.
Telemedicine in Brazil
Telemedicine has a long history in Brazil, which began mostly to serve isolated rural communities in the Amazon and similar large regions with few medical specialists. Telemedicine in this setting has been very successful. Patients and local doctors can consult with specialists in larger medical centers to guide diagnosis and treatment. Some specialties particularly appropriate for this are cardiology and radiology, where distant specialists can review test results and guide local doctors.
However, this study from the University of California gives a cautionary message about how telemedicine can fail if not done properly. Just sending in a few photographs to get a diagnosis is far from ideal medicine. Nothing substitutes for a good back and forth encounter between a doctor and a patient, with each asking questions of the other.
Telemedicine done responsibly
However, telemedicine does have a bright future, and when done carefully, can provide diagnosis and treatment often faster and less expensively than visiting a doctor. And for those isolated from major cities, telemedicine can save people from making long trips to receive care. But no matter where we live, telemedicine will grow in Brazil, and we should all work to ensure it is done properly.
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