Telemedicine…trade off of convenience over proper diagnosis ?

telemedicineStudy Finds Misdiagnosis, Prescription Errors In Teledermatology

Research reveals virtual visits may be less than effective in treating patients.

By Christine Kern, contributing writer

A study of 16 online telemedicine companies published by JAMA Dermatology revealed some online physicians misdiagnosed skin cancer, herpes, and syphilis and also prescribed medication without taking a patient’s medical history.

The article, Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease, asserts that, while evidence supports the use of teleconsultation to increase patient access to dermatological services, “Little is known about the quality of rapidly expanding direct-to-consumer (DTC) telemedicine websites and smartphone apps diagnosing and treating skin disease.”

The study sought to assess the performance of these DTC teledermatology services and found while telemedicine has the potential to expand access to high-value healthcare, there are serious concerns regarding the quality of skin disease diagnosis and treatment provided by many DTC websites. The authors concluded, “Ongoing expansion of health plan coverage of these services may be premature. Until improvements are made, patients risk using healthcare services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination.”

As part of the study, researchers created several fake skin condition scenarios and downloaded stock photos of them with prepared medical histories of “patients” if the physicians asked for them. Diagnoses were provided in 48 of 62 completed online visits and 31 prescribed medications, but only 10 patients were advised about potential risks or side effects. Less than 30 percent of the sites allowed users to select their own clinician.

“The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study.

The Wall Street Journal reported DTC telemedicine services have seen a recent growth in popularity, and the American Telemedicine Association anticipates there will be more than one million virtual medical visits this year alone. But while telemedicine is being touted as convenient and inexpensive, and as a way to expand coverage to those in underserved areas, there is also growing concern among some physician groups the services are undermining doctor-patient relationships deteriorating the quality of care and undermining the healthcare system as a whole.

Another study published by JAMA Internal Medicine questioned the effectiveness of telemedicine, especially in the synchronous variety of telemedicine found in video and phone consults. Variation in Quality of Urgent Health Care Provided During Virtual Visits found these methods of providing virtual care to patients often fail to adhere to clinical best practices.

One Response

  1. More depersonalization via technology. I realize that this is a nascent utilization of a reasonably new technology and there are still bugs to be worked out. Just the same, I reckon that someone sees a big bushel of bucks to be had and that’s why it is going to be promoted as the new panacea of “affordable” medical access. It’s much easier to end the visit with a click of the mouse and move on to the next patient when the interaction takes place in the virtual world. It seems to be that the real motive will be increased production, but at what cost? What I’m inferring here is an amalgam of things that I’m aware of that are not part of this piece that Steve posted, hence my remark about increased production.

    There’s more to be lost here than just the simple human touch that is part the technical side of an examination. I’m concerned that this might become a significant part of the health care delivery system by the time we reach the middle of this century. I wonder how many will needlessly suffer and how many will die if the financial ROI ends up making this kind of medical service provision too tempting for the corporate players to pass up. Don’t get me wrong. I do see a place for this in certain situations. Still, face to face human interaction, the kind one gets with another sitting in the same room, offers a value that is in part, intangible and yet necessary.

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