Telemedicine may have a failure to communicate

Telemedicine may have a failure to let patients and doctors communicate effectively. Melinda Beck in The Wall Street Journal writes, “Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results.”

She quotes Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study, published online in JAMA Dermatology on Sunday, as saying, “The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses.”

She also quotes Ateev Mehrotra, an associate professor of health-care policy at Harvard Medical School who wasn’t involved with the current study, as saying many dermatologists don’t accept Medicaid, and a $35 to $95 online visit may be all some patients can afford. He also noted that other studies have shown problems with in-person visits as well.

For the JAMA study, researchers created fictitious scenarios and submitted downloaded stock images to telemedicine websites.

Diagnosis of conditions that could be identified by photos alone were generally correct, the researchers found. However, diagnoses were generally less accurate for conditions requiring information beyond the photo.

The researchers noted that they did not have a control group of patients seeking similar diagnoses in a traditional setting. However, Beck quotes Resneck as saying, “The usual give-and-take that occurs between a physician and a patient wasn’t happening during these electronic consultations. The clinicians weren’t asking basic follow-up questions.”

Beck reports that two of the telemedicine companies linked patients to physicians overseas, and researchers could find no evidence that the doctors were licensed in California, where the patients resided. The CEO of one of the firms said that since the images were uploaded anonymously to the physicians, and the physicians responded anonymously, no patient-doctor relationship existed.

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