What a photo can tell a doctor

A primary care doctor takes a photo of the lesion that a patient has on the skin. The image, together with a clinical report, reaches a dermatologist through an official app or a secure channel. The specialist analyzes her after a few days and determines that she is a patient with severe psoriasis (an immune-mediated inflammatory disease). The dermatologist sends him a blood test and asks the doctor for a referral. The patient comes to the appointment with the results and the dermatologist prescribes a treatment. Thanks to the telematic communication, the patient can begin to be treated from the first visit to the specialist without the need to make a trip just to be prescribed the necessary analytics. Teledermatology, which connects patients, health centers and dermatologists, filters to detect which patients need quick attention and which do not require a specialist visit. This form of consultation is increasingly rooted in public health.

Rosa Taberner, a dermatologist at the Son Llàtzer University Hospital (Palma), trusts that this practice will become widespread but at the same time ensures : “It will not replace the face-to-face consultation. It serves to give an opportunity to the patient who needs an urgent visit to the specialist ”. Teledermatology was devised to treat potential melanomas quickly. If the primary care doctor detects that a growing black spot may constitute a case of cancer, he sends a photo to the specialist. Other channels were and are to speak with the management of the health center to refer him to the dermatologist promptly, but teledermatology accelerates these processes even more. Taberner sums up: “The system becomes more equitable and becomes less saturated.”

La dermatóloga Rosa Taberner.
The dermatologist Rosa Taberner. Personal file

It is intuitive to think that the telematic connection is at the service of the most serious cases and it is, but it also helps a patient with highly controlled psoriasis reduce their four or five annual visits to the dermatologist. “It is very useful for follow-up. I see the tests and I renew the treatment, ”says Taberner. “It is as important for those more serious cases as for the milder ones”, adds this dermatologist who has worked since 2002 in which it was “the first hospital in Spain without papers ”. The system appreciates the screen for that gap that is freed or because time is distributed more productively. The agendas are no longer uniform: one patient can receive care of 30 minutes and another of three. Not everyone is seen in the 10 or 12 stipulated minutes.

Technology but also continuous training

On the other side of that invisible line that is drawn between health personnel is Juan Jurado, a primary care physician in a nursing home. health in Medina del Campo (Valladolid). Jurado points out the key so that referrals to the specialist – and the use of teledermatology – are as accurate as possible: “Training”. Responsible for Dermatology of the Spanish Society of General and Family Physicians (SEMG), he has been instructing colleagues for years to be able to detect a possible case of cancer, and then send a photo to the dermatologist to act quickly, or diagnose a type very rare psoriasis. In the end, it is a question of making adequate use of teledermatology, although not because it is faster has to resort to these consultations in an uncontrolled way.

Jurado is very familiar with the use of the dermatoscope ( a device to study skin lesions) and with imaging. He takes photos of patients every day with their consent. “Authorization is requested. Everyone agrees, they see it as a help ”. The images are uploaded to a clinical document repository and immediately removed from the terminals. Your center is waiting to receive two mobile phones with which to take pictures, devices with already very powerful cameras.

There is a lot ahead

This way of remote diagnosis is in an initial phase. Some autonomous communities have developed apps for sending images, others have launched pilot programs and some have created a secure repository of images, like a cloud, to which primary care doctors and dermatologists have access. The advances are decentralized. Each region and each health center has its own rhythms. In some cases the pandemic has accelerated it – or at least praised it – and in other situations it has slowed it down. The changes require expensive investments not only financial but also in time and training, coordination between doctors.

El médico de atención primaria Juan Jurado.
The primary care physician Juan Jurado. Personal file

David Trigos was diagnosed with psoriasis in 1998, when he had 19 years. It is defined as a complex patient due to treatment failures and comorbidities in the form of joint injuries caused by this inflammatory disease. Psoriasis affects 2.3% of the Spanish population, according to the Acción Psoriasis association. The most visible expression of this ailment is the white and red flakes or plaques on the skin, but it also affects the quality of sleep, the emotional state and increases the chances of suffering from cardiovascular diseases, diabetes or being overweight. Wheat has received telematic attention on occasion: “In the event of an outbreak, it helps to receive the correct treatment more quickly.” Psoriasis is capricious and unpredictable, it comes and goes motivated by a few days of stress, by less healthy lifestyle habits or by unknown causes beyond the patient. This Asturian of 43, who advocates a combination of teledermatology and face-to-face consultation, adds : “It can still be implemented more and better.”

Trigos is the vice-president of Euro-Pso, the federation on a European scale that brings together associations of patients with psoriasis. Like the doctors consulted, he recognizes the value of telematic care in serious patients or in urgent situations. However, Trigos points out another aspect that improves the life of any patient: “When you are traveling, in another autonomous community, teledermatology should be used to have access to your doctor wherever you are.”

How The dermatologist Taberner pointed out in the case of patients with controlled disease, Trigos points in the same direction: “People don’t want to go to hospitals or go as little as possible. And if it is essential, it is preferable to unify the visits on the same day ”. Technology helps. Like the psoriasis units existing in some hospitals that group together specialized dermatologists, rheumatologists for psoriatic arthritis cases (between 0.3% and 1% of the population suffer from this ailment), psychologists and nurses. In one way or another, in the end it is about making it easy for someone who already has it difficult.

Prescribe association

Some patients go to the internet, like this in general, in search of information. In many cases when they have not yet received the diagnosis or just after the first visit to the specialist. David Trigos, a psoriasis patient and vice president of the European federation that groups together psoriasis patients’ associations (Euro-Pso), points out the importance of “prescribing association”. Entities such as Acción Psoriasis carry out studies and surveys always with the support of dermatologists, psychologists, rheumatologists … This allows patients to handle verified and updated information on psoriasis, in this case, and the rest of associated diseases. “It is impossible for people to stop looking at Google. Associations have to be able to position ourselves well in that search engine so that patients go to quality information sources, “says Trigos, who also recalls the work of accompaniment and the opportunity they offer them to meet other patients who are in the same situation.

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