Would it be possible for you to have a dermatology consult without leaving your home?

Absolutely, if it wasn’t for bureaucratic barriers.

Dermatologists could be very successful at telemedicine, or in this case, teledermatology.  When I see kids in the clinic, I try to calm them by saying, “Its ok, I pretty much just look at stuff”.  As you might imagine, the job of a dermatologist is primarily visual.  We are in fact tested on visual recognition.  Our board certification exam, which has 300 questions, includes about 200 images.  Many times, they make it so that you can just barely tell what part of the body you are looking at.  Then they ask you a question about the disease depicted in the picture.  So, in order to answer the question, you have to be able to diagnose the condition based purely on the image.  So, can we diagnose things just by looking at them?  Yes.  Not always, but many times the answer is yes.

I love the idea of teledermatology.  The premise is simple.  You have a funny looking mole, snap me a picture on your iPhone and send it to me.  Wanting to see if your acne medicine is working well enough that we can stop oral antibiotics, or not working well enough and we need to make some tweaks?  Send me a picture.

So why am I not doing this in my practice?

The fact is that I’ve explored this and a good friend of mine has a company that provides the back end web infrastructure to make this happen.

But I can’t do it for 2 stupid reasons.

#1.  Almost no insurance will cover it, at least not in WA.  There was a bill in the WA legislature to require insurance to cover virtual visits like this, but it failed.  The bottom line is that unless you set foot in the office, insurance won’t cover your visit.

I was dismayed by this, but not deterred.  I thought well, we live busy lives.  Perhaps even if insurance didn’t pay, maybe patients would be interested in a virtual followup if the cost was relatively modest, like $50 or something.  Maybe some people would find this more convenient than having to come into the office and perhaps they would be happy to have their needs met this way.

No dice.  Next problem:

#2.  WA health care law is very gray on telemedicine.  I asked my malpractice company to look into the feasibility of virtual followups and they determined that they could not offer me liability protection for any services rendered by teledermatology because WA law was not clear about practicing medicine this way.  I detest defensive medicine-it makes me want to vomit a bit, but I love my family more than telemedicine and am not about to risk the roof over their head for something like this.

Despite all the talk about health care reform, basic, in fact really simple things like allowing doctors to do more for their patients without dragging them into the office have not occurred.