Beware Online Medical Treatment


The doctor-patient relationship is changing – and not always for the better. The latest example is treatment by online medical websites.

A study by researchers at The University of California San Francisco was recently published in JAMA Dermatology. The results warn it can be harmful to your health to take advice and treatment from online medical websites.

Melinda Beck, writing in The Wall Street Journal, says researchers posed as patients with skin conditions seeking help from 16 online telemedicine companies. Some of the online doctors misdiagnosed syphilis, herpes and skin cancer, and some prescribed medications without asking key questions about patients’ medical histories or warning of adverse effects. Two of the sites linked consumers with doctors located overseas who aren’t licensed to practice medicine where the patients were located, as required by state law.

“The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist at UC San Francisco and lead author of the study. Ateev Mehrotra, an associate professor at Harvard Medical School who wasn’t involved in the study, said it “identifies a number of egregious quality issues that raise significant concern.”

Direct to consumer telemedicine services have exploded, with more than one million virtual medical visits expected this year, according to the American Telemedicine Association, a trade group. Some insurers are covering such services, promoting them as a convenient and low-cost alternative to traditional treatment. Online visits generally cost $35 to $95 per visit.

The study involved seven general medicine websites and nine dermatology websites. Researchers created six fictitious scenarios, used stock photos of the skin ailments and prepared more detailed medical histories for the fake patients to provide if asked.

Study Results

Of the 62 completed online visits, clinicians mostly identified as physicians provided diagnoses in 48 cases and prescribed medications in 31 of them. But only 10 of the patients were told about relevant risks or side effects from the drugs, including possible harm to unborn babies if the patients were pregnant. Only 13 of the 62 patients were asked the name of their primary-care physician and only six of the sites offered to send records to their doctor.

Diagnoses were generally accurate when conditions were identifiable by photos alone. All seven clinicians correctly identified and properly treated stasis dermatitis, an inflammatory condition associated with poor circulation. Eleven of 14 clinicians who viewed nodular melanoma, an aggressive form of skin cancer, told the patient to see a doctor, but three offered assurance that it was benign.

Seven of nine clinicians misdiagnosed a female patient whose profile indicated a potentially life-threatening condition in which herpes spreads through eczema. Two prescribed oral prednisone, which can make the condition worse.

Diagnoses were less accurate when it was necessary to request more information. None of the 12 clinicians asked a young woman whose profile represented inflammatory acne about her irregular periods or visible facial hair, so none recognized the condition as polycystic ovarian syndrome, which requires hormonal therapies.

Jonathan Linkous, chief executive officer of the American Telemedicine Association, agreed there is a need for quality control in virtual medial consultations. The organization began an accreditation program last year to set higher standards; only seven telemedicine companies have been approved to date, although nearly 500 have applied.

Healthcare is rapidly changing in this evolving new world of digital technology and world-wide communication. But new does not always represent better – a fact that is especially important when it comes to your health.

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