A new trend in medicine is the idea of “telemedicine” where patients can connect with their doctors via email and text message to get advice. It’s particularly helpful in dermatology where patients can show their dermatologist a photo of a skin issue and get help quick.
Dr. Jeff Benabio is a dermatologist at Kaiser Permanente in San Diego, founder of the popular Derm Blog and an award-winning speaker invited to speak at many industry events (here’s a talk on “Reinventing the Physician” at TEDx.)
Here, he answers a few of our questions about telemedicine.
FutureDerm (FD): First, I have to know, how does it feel to be “A Rock Star of Dermatology” in Glamour Magazine?
Dr. Jeff Benabio (JB): Humbling
FD: But, really, telemedicine sounds pretty hip! Can you tell me a bit about how it works?
JB: Telemedicine uses technology to allow physicians and patients to connect virtually. It can come in a few varieties: Primary care physicians can send photos of their patients for a specialist to assist with the diagnosis and treatment (called store and forward telemedicine). A second way is that the patient can send a photo directly to a physician (also called store and forward). Patients can also connect with physicians using video (called live interactive telemedicine). This can be done from one office building to another or from a physician office building to a patient’s home or office. Lastly, mobile devices such as smartphones allow for physicians to monitor patients’ vital signs when they are at home. For example, patients can send their blood glucose levels directly from their device to their physician. This is called remote monitoring telemedicine.
FD: Do patient usually follow-up with an appointment? Does this enable you to see more patients per day?
JB: It depends. Oftentimes, yes, using telemedicine allows us to avoid an appointment for the patient. Sometimes it is still necessary for the patient to see us in person. Even in this case, the telemedicine can allow us to triage patients to see those who need it urgently more quickly. For example, if telemedicine shows a melanoma, then we can have the patient come for an appointment right away to have removed. In many instances, yes, I can see photos about 3 times faster than seeing patients in person, so it makes the physician much more efficient.
FD: What are the advantages of telemedicine? What are the disadvantages of telemedicine?
JB: Advantages include quicker access to a physician and ability for patients, particularly rural patients, to connect with a physician, many of whom would otherwise not be able to see a specialist. Other benefits to the patient include no travel time, no missed time from work, and no office wait. Benefits to the providers and payors can include delivering care more efficiently and more affordably. Disadvantages include waste that can occur if the telemedicine is inadequate to help the patient and the patient has to come in or make additional appointments anyway. Another disadvantage is that health insurance often does not cover for telemedicine visits.
FD: Do you think that you’re able to diagnose as accurately using photos that patients take themselves?
JB: Absolutely. We do this every day; however, if the quality of the photos or the video is inadequate, then we cannot make a diagnosis and cannot make recommendations for treatment.
FD: You diagnose a lot of patients via telemedicine — 40 by text and 10 by email per day — do you think we’ll see a rise in skin cancer diagnoses with the ease of reaching doctors?
JB: I hope so. Rise in diagnosis would mean that we are finding and treating more of the skin cancers that are out there. For most all skin cancers, the earlier we detect them and sooner we treat them, the less invasive and dangerous they are. In the long run, we can reduce morbidity and mortality and save health care costs.
FD: What are some tips you have for readers about how to best use telemedicine?
JB: Ask their provider if they are able to use telemedicine as a way to help them or answer questions.
FD: Where do you see medicine and telecommunications going in the future?
JB: Direct to the consumer. In this fashion, patients will pay a fee to have a licensed provider help them anywhere, anytime without worrying about if the service is covered by their insurance.
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