Dermatology: Be aware of who’s providing your care

AMERICAN ACADEMY OF DERMATOLOGY EXPERT

Information provided by Carrie Kovarik, MD, FAAD, associate professor, dermatology, dermatopathology and infectious diseases, University of Pennsylvania, Philadelphia.

GOING REMOTE Because dermatology is such a visual specialty, Dr. Kovarik says, dermatologists were among the first specialists to utilize remote consultations, also known as telemedicine. Dermatologists have been evaluating disease images and discussing conditions over the phone for decades, she says, and the use of teledermatology has increased as technology has developed to accommodate it. Today, she says, patients can utilize computers and mobile devices to access dermatologic care when it might not otherwise be available, whether it's because of insufficient insurance coverage, problems getting to the doctor's office, or a lack of available dermatologists in rural areas or inner cities.

Although some dermatology services can't be performed adequately via remote consultation, Dr. Kovarik says, questions about an easily photographable problem like a rash or a suspicious spot are appropriate for teledermatology. Remote consultations also may be utilized for triage, allowing a doctor to provide an initial evaluation of a problem and determine how soon the patient needs to come into the office, she says.

POTENTIAL PROBLEMS

The growth of remote consultation services has included the development of direct-to-consumer websites and apps that patients can access themselves via their computers, tablets and smartphones. While these services may be convenient, Dr. Kovarik advises caution in utilizing them.

"A lot of patients are aware of these products and have probably seen them advertised," she says. "However, there are no regulations in place to ensure the quality of teledermatology services, so it's important to do your due diligence before seeking a remote consultation online or via a mobile app."

Not all teledermatology services offer consultations with a licensed, board-certified dermatologist, Dr. Kovarik says, and many don't let patients re-contact their initial provider for follow-up questions. Additionally, some services don't allow patients to submit photos, she says, which makes an accurate diagnosis difficult.

About 20 percent of patients who receive remote consultations require an in-person follow-up visit, Dr. Kovarik says, but not all services have a system in place to arrange such visits. Plus, she says, receiving a consultation from a provider who has no access to your medical records or history can lead to duplicated or fragmented care.

WHAT YOU CAN DO

Dr. Kovarik encourages patients to seek remote consultations from the health system they utilize for other medical care. This will allow them to work with an existing health team, alleviating many of the possible issues encountered with direct-to-consumer services. If this is not possible, however, she offers the following tips for evaluating remote consultation services:

•Know your provider. You should only receive a consultation from a board-certified dermatologist who is licensed in your state. Ask for the provider's credentials; if a remote consultation service won't provide those credentials, don't use that service.

•Be choosy. Only use teledermatology services that allow you to select the dermatologist of your choice for your consultation.

•Make sure to share. A quality teledermatology service should give you the opportunity to share your medical history and obtain a record of your consultation to share with your primary care provider or dermatologist.

•Have a backup plan. Before engaging in a remote consultation, make sure the service has a plan in place to arrange for an in-person visit with a dermatologist in your area if your problem can't be resolved remotely. Make sure this visit would take place in a physician's office, rather than the emergency room.

•When in doubt, go to the doctor. Don't rely exclusively on remote consultations for dermatologic care. If you have a serious condition or one that can't be evaluated remotely, make an appointment to visit a doctor in person.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE

"Remote consultations are a great option for patients, especially those without easy access to in-person dermatologic care," Dr. Kovarik says. "However, it's important for patients to understand that there are a wide variety of teledermatology services available, and some of them are better than others. Before engaging in a remote consultation, patients should evaluate the teledermatology service to ensure they'll be receiving quality care."