Avis dermatologiques à distance : une enquête interrégionale

Abstract

General practitioners and specialists often seek advice from dermatologists based on digital pictures. This time-consuming activity is currently not valued nor well-established. We therefore conducted a survey to assess the extent and nature of such requests. A questionnaire was sent to dermatologists working either at university hospitals or in private practice in three regions of France (Loire Atlantique, Rhone Alpes and Normandy). For two months, the dermatologists completed the same questionnaire for each specialized request. The following items were recorded: status of the dermatologist asked to provide a specialized opinion, region in which the request was made, status of the requesting practitioner, mode of request, type of disease, question asked, time taken to answer the request and result of the specialized advice. Thirty dermatologists, including 11 in private practice, participated in this study. We identified 287 requests. The majority of these requests came from general practitioners (30%) and dermatologists working in private practice (29%). These requests were sent by e-mail using a non-secure professional e-mail address in 49% of cases or via smartphone in 29% of cases. The purpose of the requests was either diagnostic/therapeutic (36%) or solely therapeutic (39%). Relevant requests concerned dermatological manifestations in paediatric or cancer patients (23% and 21% respectively), general dermatological diseases (21%) and wound management (14%). Nearly half of the specialized advice was provided in under 5minutes, and in 60% of cases a consultation with a dermatologist was avoided. Despite the small number of physicians taking part in the study, this non-exhaustive survey confirms the usefulness of remote dermatological reviews and consultations, and identifies the main intervening physicians involved in this type of procedure. The study also raises potential medico-legal issues regarding the lack of data security covering medical information. There is thus a need for dermatologists to organize their activity in order to respond to such requests without exposing themselves to medico-legal consequences.