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Research Letter |

The Accuracy of Diagnosis of an Online Consultation Service Compared With Physical Consultation With a Dermatologist

Evelyn Grünig, MMed1; Sabine Schmidt-Weitmann, MD2; Christiane Brockes-Bracht, MD2; Günther F. L. Hofbauer, MD1
[+] Author Affiliations
1Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
2Department of Clinical Telemedicine, University Hospital Zürich, Zürich, Switzerland
JAMA Dermatol. 2015;151(12):1375-1376. doi:10.1001/jamadermatol.2015.2537.
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This study of an email-based online dermatology consultation service found that absence of differential diagnosis was a significant factor in diagnostic confidence.

The division of Clinical Telemedicine at University Hospital Zürich in Switzerland has run an email-based online consultation service for laymen since 1999, offering a physical consultation when deemed appropriate.1 We compared the adequacy of online diagnosis with the benchmark of an in-person dermatological consultation.

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Figure 1.
Differential Diagnoses and Concordance

The mention of differential diagnosis is inversely associated with diagnostic concordance. The graph shows the distribution of all cases with concordant and discordant diagnosis divided into those with and without mention of differential diagnosis. Data are plotted for both online and physical consultations together for clarity’s sake, with both kinds of consultations showing a clear association (online differentials, χ2P = .001; consultation differentials, χ2P < .001).

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Figure 2.
Type of Physician Contact and Diagnostic Concordance

The type of previous physician contact is associated with discordance of diagnosis between online and physical consultation. Previous physician contacts were categorized as no physician contact, contact with a general practitioner only, a dermatologist only, both a general practitioner and a dermatologist, more than 1 dermatologist, and with another specialist. Data are shown for 80 patients; data were missing for 8 patients (χ2P = .02).

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