Review of telemedicine finds misdiagnoses of skin conditions

Doctors contacted during a recent study failed to verify patient identification and misdiagnosed conditions from eczema to herpes and cancer.

By Stephen Feller

SAN FRANCISCO, May 17 (UPI) -- Although telemedicine has been shown in some studies to be effective, as well as preferable for some patients, a recent experiment suggests there are limitations on the ability of doctors to diagnose or treat some conditions without an office visit.

Researchers at the University of California San Francisco reviewed telemedicine services and report many doctors either misdiagnosed or entirely missed conditions that could be contagious or life-threatening, suggesting a combination of technological challenges and poor doctor qualification potentially being the cause.


Telemedicine -- the use of video, pictures and other technology for long-distance doctor's visits -- has been encouraged by several doctors organizations because it can increase access to care and caregivers, reduce cost and travel burden for patients and enhance the relationship between doctor and patient.

Recent studies have found surgical patients preferred telemedicine visits with their doctors when possible because of convenience, and that it could effectively help doctors work with autistic children and their parents.

But in the new study, services were not based on previous doctor-patient relationships and physicians failed to ask key questions, causing them to miss conditions from sexually transmitted disease to cancer.


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

For the study, published in the journal JAMA Dermatology, researchers created a series of simulated dermatologic cases, using regional and national telemedicine websites and smartphone apps to test their diagnostic and treatment services.

In the doctor's visits, researchers found no clinician asked for identification or raised concerns about potentially falsified identification or claims of symptoms in 62 clinical encounters with 16 telemedicine companies.

Overall, 68 percent of patients were assigned a doctor without a choice. Of those, just 26 percent discussed being licensed physicians, with many using using international licenses to practice. On top of this, just 23 percent asked about the fictional patient's primary care physician and 10 percent offered to forward records of treatment to a primary care physician.

The services offered a diagnosis or likely diagnosis with suggested in-person follow-up 77 percent of the time and prescriptions were ordered in 65 percent of cases with a diagnosis. Among these, however, doctors missed diagnoses including secondary syphilis, eczema herpeticum, gram-negative foliculitis and polycystic ovarian syndrome.


The American College of Physicians released guidelines for doctors using telemedicine last year, part of which was specifically aimed at building relationships with patients when treating them from remote locations.

"Telemedicine has potential to expand access to high-value health care. Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many direct to consumer telemedicine websites," researchers wrote in the study. "Ongoing expansion of health plan coverage of these services may be premature. Until improvements are made, patients risk using health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination."

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