Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme - Final report volume 2

Relationship between visiting services and Tele-Derm

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Dermatology is fairly unique in the medical field in that diagnosis is the most challenging aspect of the practice. Generally, prescribing and treatment are fairly straightforward. What this means is that the speciality is extraordinarily well suited to telemedicine as such a large percentage of cases can be diagnosed through pictures and case histories. This means that a significant portion of visiting dermatology service can be replaced with Tele-Derm.

The other important issue in telemedical services is the treatment and follow up of issues that have been diagnosed. Traditional visiting services required patients to wait for the visiting specialist to return or for their local doctor to follow up with their care. Often the visits by the specialist could be far apart and the local doctor might not have sufficient initiative, knowledge or information to provide comprehensive care.

Tele-Derm addresses a lot of these issues through the combination of education and telemedicine services. Having the doctor take pictures and a case history involves the doctor in the case directly, providing both knowledge, ownership and initiative in the treatment of the patient. Furthermore, the availability of educational resources on the Tele-Derm site provides the resources to allow GPs to perform many procedures that are essential for dermatology. Many of these are straightforward and most competent doctors can already do or learn them through the tutorials Dr. Muir has provided online. Cases can also be addressed through the back log of cases provided online, allowing GPs to research a condition and make a diagnosis without consulting a dermatologist directly.

The overall assessment of telemedicine versus visiting dermatology services is that they do not have to be as good as face to face, they just have to be better than what is currently available. In the public sector, there are six month to year long waiting lists for dermatology, whereas Tele-Derm can have a turnaround of less than a day. Most dermatologists are located in major cities or large regional centres, meaning that a significant amount of travel time is required by rural patients. Tele-Derm only requires them to travel to their local GP. Overall, the service offers significant benefit and provides no more risk of misdiagnosis or mistreatment than a face to face consultation with a dermatologist. One final benefit of the Tele-Derm program is that it can reduce professional isolation for doctors, increase their confidence in diagnosis and help them to feel more connected to the medical profession.