Tags: Cancer | telemedicine | misdiagnose | skin | problems | cancer

Telemedicine Sites Misdiagnose Deadly Skin Cancer

Telemedicine Sites Misdiagnose Deadly Skin Cancer
(Copyright AP)

By    |   Monday, 16 May 2016 12:10 PM


A study using fake patients to gauge the performance of online telemedicine companies produced disturbing results: Of the 16 companies examined, some doctors misdiagnosed skin cancer, herpes, and syphilis. Some also prescribed medications without asking vital questions about the patient's medical history and didn't warn of side effects.

Although direct-to-consumer teledermatology (DTC) is rapidly expanding and large DTC services are contracting with major health plans to provide telecare, little is known about their  quality.

Researchers at the University of California, San Francisco posed as patients to submit six dermatologic cases with photographs, including tumors, inflammatory and infectious conditions, to regional and national DTC telemedicine websites using smartphone apps. Most of the photographs were obtained from online image search engines.

The fake patients claimed to be uninsured, and paid charges using Visa gift debit cards. No participants gave any false information, such as fake government-issued identification cards or numbers.

The California researchers received responses from 16 DTC websites for 62 clinical encounters from February to March 2016. According to The Wall Street Journal, diagnoses were generally correct when they were identifiable by photos alone.

All clinicians correctly diagnosed and treated  stasis dermatitis, an inflammation of the lower legs caused by poor circulation and characterized by itchy, scaling skin with hyperpigmentation (darker patches of skin).

But potentially deadly conditions sometimes went undiagnosed. While 11 of 14 clinicians who examined photos of nodular melanoma, an aggressive form of skin cancer, told the patient to see a doctor in person, three were convinced the condition was benign. Other major conditions the clinicians missed included  secondary syphilis and polycystic ovarian syndrome.

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

"Telemedicine has potential to expand access, and the medical literature is filled with examples of telehealth systems providing quality care," the study author wrote. "Our findings, however, raise doubts about the quality of skin disease diagnosis and treatment being provided by a variety of DTC telemedicine websites and apps.

"We believe that DTC telemedicine can be used effectively, but it is best performed by physicians and team members who are part of practices or regional systems in which patients already receive care," they concluded.

According to the American Telemedicine Association, Americans will engage in more than one million virtual medical visits in 2016, and some insurers cover them in hopes of bringing down costs.

The article was published in JAMA Dermatology.


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A study using fake patients to gauge the performance of online telemedicine companies produced disturbing results: Of the 16 companies examined, some doctors misdiagnosed skin cancer, herpes, and syphilis. Some also prescribed medications without asking vital questions...
telemedicine, misdiagnose, skin, problems, cancer
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2016-10-16
Monday, 16 May 2016 12:10 PM
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