Since it was deployed in all regions of Quebec two years ago, teledermatology has allowed thousands of patients to have a dermatology consultation more quickly. However, this tool does not seem to significantly reduce waiting lists.
Teledermatology is currently only available to family physicians. When they have dermatological cases, physicians registered for this service will take photos of their patient’s lesion and fill out a questionnaire to provide additional information to the dermatologist.
Depending on the severity of the case, dermatologists have up to two weeks to respond. They have the option of declining the request – most often this is due to poor photo quality. They can also ask to see the patient in person if they feel, for example, that surgery or a biopsy is necessary, but most of the time this can be avoided.
The president of the Association of Medical Specialists in Dermatology of Quebec (AMSDQ), DD Catherine Besner Morin, said that two times out of three, in teledermatology requests, it is not necessary to see the patient in person. “That being said, we do not have [retour] to really know if everything resolved as we thought it would resolve. So, there may be a proportion of these people who will end up in a dermatologist’s office,” she qualifies.
The third option of the dermatologist is to give the family doctor a main diagnostic hypothesis and a course of action to follow, for example recommending a certain treatment or explanations to give to the patient.
According to DD Besner Morin, the main advantage of teledermatology is that it allows patients living in remote areas or those poorly served for this specialty to receive care more quickly. She herself makes her services available for the Mauricie–Centre-du-Québec region for which there is a long wait, she says.
“I tell myself that every consultation I do and every patient I help, maybe they would have waited months or even years to see someone. I help my dermatologist colleagues in this region by reducing the burden and I help patients who don’t have good access. I find it very rewarding to do teledermatology for this region, it’s a bit like redistributing resources,” says Dr. Besner Morin.
In short, she believes that teledermatology is a success in Quebec, emphasizing that the platform works well and that the number of registered dermatologists remains stable (there are currently 47).
There are also thousands of general practitioners who use the teledermatology service. In the last three months, approximately 3,600 consultations have been carried out and the AMSDQ estimates that this should increase to 15,000 consultations for the coming year.
However, this tool has its limitations and it does not replace an in-person consultation. Teledermatology carries an increased risk of diagnostic error and for this reason some dermatologists will always remain reluctant, according to DD Besner Morin.
She also doesn’t think that teledermatology will reduce the long waiting lists in Quebec. “Fifteen thousand [consultations]it seems like a lot, but in dermatology we are the specialty with the highest number of new annual consultation requests,” she says.
The AMSDQ estimates that in the last year the 200 dermatologists affiliated with the Régie de l’assurance maladie du Québec (RAMQ) carried out 270,000 new consultations in addition to 450,000 follow-ups.
Supporting dermatologists
To improve access to dermatologists, it is essential to increase the number of these professionals, stresses DD Besner Morin: “Our consultations must be relevant. We must have a strong front line so that when they need our help, we are sent consultations that really need dermatological care and our expertise,” she adds.
The AMSDQ president does not think that the solutions to reduce waiting lists involve teledermatology. She sees this service as a complementary tool. “It is not a debit object, it is an object to provide care to people who would have had difficulty receiving dermatology care. It is a teaching tool for family doctors […] because we give them feedback,” she explains.
DD Besner Morin wants dermatologists to be better supported in their practice. She criticizes in particular the lack of premises allocated to them in hospitals. In addition, almost everywhere in the health network, dermatologists lack access to nurses and secretaries.
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